Tuberculosis Is Rising in Mississippi: What Every Resident Should Know

What TB is

Tuberculosis is an infection caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can affect other organs. TB spreads through airborne droplets when an infected person coughs, sneezes, or speaks. Casual contact (sharing food, brief encounters) does not typically transmit it. Sustained close exposure (living with an infected person, working closely in confined spaces) is the typical route of transmission.

Latent vs active TB

Most people who are exposed to TB develop latent TB infection, meaning the bacterium is present but not causing illness. The immune system contains it. Latent TB does not produce symptoms and is not contagious. About 5 to 10 percent of people with latent TB will eventually develop active TB if untreated, with the risk higher in immunocompromised patients.

Active TB causes symptoms (cough, fever, night sweats, weight loss) and is contagious. It requires immediate treatment and isolation precautions until the infectious period has passed.

Who is at higher risk

• Close household contacts of someone with active TB.
• Healthcare workers, particularly in settings serving high risk populations.
• People who have lived or traveled extensively in countries where TB is more common.
• People who are immunocompromised (HIV, cancer treatment, transplant medications, certain biologics for autoimmune disease).
• People with diabetes, which roughly triples TB risk.
• People with chronic kidney disease, silicosis, or significant smoking history.
• People in correctional facilities, long term care, or shelters.
• People with substance use disorders, particularly injection drug use.

Testing for TB

Two tests are commonly used.

• Tuberculin skin test (TST), also called PPD. A small injection in the forearm, read 48 to 72 hours later. The size of the skin reaction indicates likely TB exposure.
• Interferon gamma release assay (IGRA), a blood test. More specific than the skin test and not affected by prior BCG vaccination, which is given in some countries.

A positive test indicates exposure, not necessarily active disease. Active TB diagnosis requires further testing, including chest X-ray and sputum analysis.

The medications

For latent TB

Several treatment regimens are used. Common options include isoniazid for 6 to 9 months, rifampin for 4 months, or a combination of isoniazid plus rifapentine (3HP) given weekly for 12 weeks. The shorter regimens are increasingly preferred because they improve completion rates.

For active TB

Active TB requires multiple medications taken together to prevent resistance from developing. The standard initial regimen uses four medications: isoniazid, rifampin, pyrazinamide, and ethambutol. After 2 months, the regimen is typically continued with two medications for an additional 4 to 7 months, depending on the situation.

Side effects to watch for

• Liver effects. Several TB medications can affect the liver. Routine blood tests during treatment monitor for this. Yellowing of the skin or eyes, dark urine, or persistent nausea requires immediate medical attention.
• Numbness or tingling in the hands and feet (peripheral neuropathy). Isoniazid can cause this. Vitamin B6 supplementation during treatment prevents it for most patients.
• Vision changes. Ethambutol can affect vision. Any change in vision during treatment requires immediate evaluation.
• Orange discoloration of body fluids. Rifampin causes urine, sweat, tears, and saliva to turn orange. This is harmless but can stain contact lenses and clothing.
• Rash, fever, or flu like symptoms. These can indicate a hypersensitivity reaction and need evaluation.

Drug interactions

Rifampin is one of the most potent inducers of liver enzymes in pharmacy. It dramatically reduces the levels of many other medications, including:

• Hormonal birth control. Backup contraception is needed during rifampin treatment.
• Many HIV medications.
• Several heart and blood pressure medications.
• Anticoagulants, including warfarin and the direct oral anticoagulants.
• Many psychiatric medications.
• Several diabetes medications.

Any patient on rifampin needs a full medication review with a pharmacist. The interactions are too numerous to manage without one.

Public health and confidentiality

TB is a reportable disease in Mississippi. Cases are reported to the Mississippi State Department of Health, which coordinates contact tracing. This is to identify others who may have been exposed and protect the community. The process is confidential and is intended to support, not stigmatize, patients with TB.

Treatment for TB is provided at no cost to patients through public health services in Mississippi. If you have been diagnosed with TB, the Mississippi State Department of Health TB control program coordinates your care, often in partnership with your primary care provider.

Where pharmacy fits

Pharmacists in Mississippi work with the public health system, infectious disease clinics, and primary care prescribers to support TB patients. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You have been told you have a positive TB test (latent or active).
• You are starting TB medications.
• You are on TB medications and have noticed side effects.
• You take other prescriptions and have been started on rifampin.
• You have been in close contact with someone diagnosed with active TB.
• You are pregnant or breastfeeding and have been told you need TB treatment.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.