Tuberculosis (TB) is a potentially serious infectious disease that primarily affects your lungs.

Tuberculosis is spread from person to person through tiny droplets released into the air. Most people who become infected with the bacteria that cause tuberculosis don't develop symptoms of the disease. Despite advances in treatment, TB remains a major cause of illness and death worldwide, especially in Africa and Asia. Every year tuberculosis kills almost 2 million people. Since the 1980s, rates of TB have increased, fueled by the HIV/AIDS epidemic and the emergence of drug-resistant strains of the TB bacteria. Most cases of tuberculosis can be cured by taking a combination of medications for several months or longer. It's important to complete your whole course of therapy. Symptoms By Mayo Clinic staff Although your body may harbor the bacteria that cause tuberculosis, your immune system often can prevent you from becoming sick. For this reason, doctors make a distinction between:

Fever Night sweats Chills Loss of appetite Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:

Coughing that lasts three or more weeks Coughing up blood Chest pain, or pain with breathing or coughing Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine. When to see a doctor See your doctor if you have a fever, unexplained weight loss, night sweats and a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause. TB can be diagnosed by your primary care doctor or by a doctor who specializes in lung diseases (pulmonologist) or by an infectious disease specialist. If you don't have a doctor, your local public health department can help. Causes By Mayo Clinic staff Tuberculosis is caused by an organism called Mycobacterium tuberculosis. The bacteria spread from person to person through microscopic droplets released into the air. This

Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious. Active TB. This condition makes you sick and can spread to others. Signs and symptoms of active TB include:

Unexplained weight loss Fatigue

can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings. Rarely, a pregnant woman with active TB may pass the bacteria to her unborn child.

spread from the cavities to the rest of your lungs as well as to other parts of your body.

Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from a family member or close co-worker than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.

If you have active TB, you're likely to feel sick. Even if you don't feel sick, you can still infect others. Without treatment, many people with active TB die. Those who survive may develop long-term symptoms, such as chest pain and a cough with bloody sputum, or they may recover and go into remission.

TB infection vs. active TB If you breathe TB bacteria into your lungs, one of four things might happen:

You don't become infected with TB. Your immune system immediately destroys the germs and clears them from your body. You develop latent TB infection. The germs settle in your lungs and begin to multiply. Within several weeks, however, your immune system successfully "walls off" the bacteria in your lungs, much like a scab forming over a wound. The bacteria may remain within these walls for years alive, but in a dormant state. In this case, you're considered to have TB infection and you'll test positive on a TB skin test. But you won't have symptoms and won't transmit the disease to others. You develop active TB. If your immune defenses fail, TB bacteria begin to exploit your immune system cells for their own survival. The bacteria move into the airways in your lungs, causing large air spaces (cavities) to form. Filled with oxygen which the bacteria need to survive the air spaces make an ideal breeding ground for the bacteria. The bacteria may then

You develop active TB years after the initial infection. After you've had latent TB for years, the walled-off bacteria may suddenly begin multiplying again, causing active TB, also known as reactivation TB. It's not always clear what triggers this reactivation, but it most commonly happens after your immune system becomes weakened. Your resistance may be lower because of aging, drug or alcohol abuse, malnutrition, chemotherapy, prolonged use of prescription medications such as corticosteroids or TNF inhibitors, and diseases such as HIV/AIDS. Only about one in 10 people who have TB infection goes on to develop active TB. The risk is greatest in the first two years after infection and is much higher if you have HIV infection.

HIV and TB Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Tuberculosis and HIV have a deadly relationship each drives the progress of the other.

Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to

progress from latent to active disease than are people who aren't HIV-positive.

TB is one of the leading causes of death among people with AIDS, especially outside the United States. One of the first indications of HIV infection may be the sudden onset of TB, often in a site outside the lungs.

Drug-resistant TB Another reason TB remains a major killer is the increase in drug-resistant strains of the bacterium. Ever since the first antibiotics were used to fight TB 60 years ago, the germ has developed the ability to survive attack, and that ability gets passed on to its descendants. Drugresistant strains of TB emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well. Today, for each major TB medication, there's a TB strain that resists its treatment.

Extensively drug-resistant TB (XDR TB). XDR TB is a less common form of MDR TB in which the bacteria resist isoniazid and rifampin as well as most of the alternative or second line drugs used to treat TB. XDR TB has shown up across the world, including 49 cases in the United States between 1993 and 2006. Treatment for XDR TB is challenging and lengthy and leads to serious side effects and a higher rate of failure. Recently, the first cases of completely drugresistant TB were reported the bacteria could not be killed by any available TB drug. Risk factors By Mayo Clinic staff Anyone can get tuberculosis, but certain factors increase your risk of the disease. These factors include:

The major cause of TB drug resistance is inadequate treatment, either because the wrong drugs are prescribed or because people don't take their entire course of medication.

Lowered immunity. A healthy immune system can often successfully fight TB bacteria, but your body can't mount an effective defense if your resistance is low. A number of factors can weaken your immune system. Having a disease that suppresses immunity, such as HIV/AIDS, diabetes, end-stage kidney disease, certain cancers or the lung disease silicosis, can reduce your body's ability to protect itself. Your risk is also higher if you take corticosteroids, certain arthritis medications, chemotherapy drugs or other drugs that suppress the immune system. Close contact with someone with infectious TB. In general, you must spend an extended period of time with someone with untreated, active TB to become infected yourself. You're more likely to catch the disease from a family member, roommate, friend or close co-worker. Country of origin. People from regions with high rates of TB especially sub-Saharan Africa, India, China, the islands of Southeast Asia and Micronesia, and parts of the former Soviet Union are more likely to develop TB. In the United States, more than half the people with TB were born in a different country.

There are two types of drug-resistant TB:

Multidrug-resistant TB (MDR TB). This form of TB can't be killed by the two most powerful antibiotics for TB, isoniazid and rifampin. Although MDR TB can be successfully treated, it's much harder to combat than is regular TB and requires long-term therapy up to two years with drugs that are very expensive and can cause serious side effects. People with untreated MDR TB can transmit this serious type of TB to others.

Among these, the most common countries of origin were Mexico, the Philippines, India and Vietnam.

Age. Older adults are at greater risk of TB because normal aging or illness may weaken their immune systems. They're also more likely to live in nursing homes, where outbreaks of TB can occur. Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to TB. Malnutrition. A poor diet or one too low in calories puts you at greater risk of TB. Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB. Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of TB. That's because the risk of the disease is higher anywhere there is overcrowding and poor ventilation. Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of TB infection. Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand washing greatly reduce your risk. International travel. As people migrate and travel widely, they may expose others or be exposed to TB bacteria. Prevention By Mayo Clinic staff

In general, TB is preventable. From a public health standpoint, the best way to control TB is to diagnose and treat people with TB infection before they develop active disease and to take careful precautions with people hospitalized with TB. But there also are measures you can take on your own to help protect yourself and others:

Keep your immune system healthy. Eat plenty of healthy foods including fruits and vegetables, get enough sleep, and exercise at least 30 minutes a day most days of the week to keep your immune system in top form. Get tested regularly. Experts advise people who have a high risk of TB to get a skin test once a year. This includes people with HIV or other conditions that weaken the immune system, people who live or work in a prison or nursing home, health care workers, people from countries with high rates of TB, and others in high-risk groups. Consider preventive therapy. If you test positive for latent TB infection, your doctor will likely advise you to take medications to reduce your risk of developing active TB. Vaccination with BCG isn't recommended for general use in the United States, because it isn't very effective in adults and it causes a false-positive result on a Mantoux skin test. But the vaccine is often given to infants in countries where TB is more common. Vaccination can prevent severe TB in children. Researchers are working on developing a more effective TB vaccine. Finish your entire course of medication. This is the most important step you can take to protect yourself and others from TB. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.

To help keep your family and friends from getting sick if you have active TB:

Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active TB. Ensure adequate ventilation. Open the windows whenever possible to let in fresh air. Cover your mouth. It takes two to three weeks of treatment before you're no longer contagious. During that time, be sure to cover your mouth with a tissue anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. Also, wearing a mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission.