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Thompson high school student diagnosed with active tuberculosis infection

R.D Parker Collegiate students' parents were notified by phone and email message Feb.
dr michael isaac
Northern Regional Health Authority medical officer of health Dr. Michael Isaac, seen here during a panel discussion at a fentanyl forum in Thompson in January, says the recent diagnosis of a Thompson high school student with an active tuberculosis infection does not mean that an outbreak is likely.

R.D Parker Collegiate students' parents were notified by phone and email message Feb. 15 that student at the school had an active tuberculosis infection but the Northern Regional Health Authority medical officer of health says that transmission between co-workers and classmates is rare.

"It's uncommon for coworkers or school classmates to contract TB from someone at school," said NRHA medical officer of health Dr. Michael Isaac Feb. 16. "It's possible. It's happened in the past but it's uncommon."

The most likely person for someone to contract tuberculosis (TB) from, he says, is someone that they live with.

"Transmission is more likely to happen if you've spent several hours with the person in an enclosed space with poor ventilation," says Isaac. "It typically takes many, many hours of exposure to someone with active TB before that person themselves will become infected. It's not something where you're going to walk down the hallway past someone with active disease and pick it up that way. It's just not that contagious."

There are two types of TB infections: sleeping or latent and active.

"Latent TB is when you've got TB in your body but it's not actively replicating, it's not causing any disease or any symptoms," Isaac says. " Active disease, just like the name sounds, means that it's active, you've got a bacteria in your body, it's replicating, it's causing you to have some symptoms which are cough, fever, chills, weight loss, feeling quite run down or fatigued."

Active cases are confirmed by a chest x-ray and laboratory testing of sputum, or phlegm.

"We can find certain patterns on the chest x-ray which lead us to believe that there's an active TB infection there," Isaac says. "We ask somebody to cough up phlegm from their lungs and then we send that away to a lab and they look for the TB bug in there."

Once an active infection has been confirmed, public health officials examine who that person has had contact with and determine if any of those people need to be tested via a tuberculin skin test, also known as a TST or a Mantoux test.

"The Mantoux test helps us to identify those people who have been infected with TB at some point in the past," Isaac says. "It may have been within the past few months or it could have been a few years ago that they were infected buy their body's immune system took care of the TB, walled it off and they've got latent or sleeping TB."

Testing is generally limited to those who medical personnel feel could benefit from treatment. Anyone with weakened or compromised immune system, which can include people taking immunosuppressive drugs, like some that are used to treat cancer, as well as people with HIV or diabetes that is affecting their immune system.

"When we make a decision to test for latent TB using the TST, if it's positive we will treat that person," says Isaac. "It can get a little bit complex to try and decide who to test but we try and only test people that would benefit from treatment."

TB is treated with an antibiotic called isoniazid and the usual treatment for a latent or sleeping case of TB takes nine months. Treatment is limited to those doctors think will benefit from it because isoniazid can have affect the liver of those taking it.

Isaac says Manitoba has a higher rate of TB than some other provinces and that Northern Manitoba has a higher rate than the province as a whole.

"It is not uncommon for us to have tuberculosis disease in Thompson," he says.

On the other hand, most people with latent TB will never see the bacteria reactivate to become an active infection and it is not as contagious as many other diseases.

"It's uncommon for TB to spread in a school or work environment," says Isaac. "It's not as infectious as some other communicable diseases that we have. Tuberculosis understandably can cause some anxiety in people but, again, it's not as infectious as some other agents that we've got around. Out of an abundance of caution essentially we want to make sure we test those people at the school that may have had more exposure than some other people but we're not expecting that we're going to have an outbreak at the school at this point in time."

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