Children's Community Nursing Service, Richmond
Here we explain what to expect at the Tuberculosis clinic and the tests you may need to have.
About tuberculosis
Tuberculosis is commonly called 'TB'.
TB is caused by bacteria (a type of germ).
It usually affects the lungs although it can affect any part of the body. The symptoms can therefore vary depending on the site of the infection.
Not all TB is infectious. Only TB of the lungs or throat is infectious and can be spread from person to person. The germ is spread through the air by tiny droplets expelled into the air when the infected person breaths, coughs or sneezes. For this reason, we like to see people with symptoms promptly to reduce the chance of spread and to start treatment as soon as possible.
In the UK in 2021 there were 4,125 cases of active TB.
TB can be cured with a course of medication that usually lasts for 6 months.
Active TB
You may have been referred because you have symptoms of active TB. Symptoms can include one or more of the following:
- fever and night sweats
- prolonged and unexplained cough (more than 3 weeks)
- unexplained weight loss
- blood in your phlegm
- fatigue and lethargy
- swollen glands.
Assessment and tests at the TB clinic
In the clinic you will see a TB Nurse Specialist who will ask you questions about your medical history. We will ask you where you were born and the countries you have lived in. (TB is more common in some countries, and you may have had a greater exposure to the germ). It is also important for us know if anyone in your family or friends circle has had TB in the past.
Tests can include:
- chest X-ray
- blood test
- Tuberculin skin test (a small injection in the forearm).
If you are coughing and producing phlegm, we will ask you to collect and provide samples of this on 3 consecutive morning. This is the best way for us to look for the germ.
Referral for other reasons
You may have been referred to the TB clinic for TB screening not because you are unwell or have symptoms but because we need to know if you have ever been infected with the TB germ.
Latent TB
It is possible to be exposed to TB unknowingly and this may have allowed the germ to enter your body. It does not make you ill at the time because the immune system deals with this infection by containing it and sending it to sleep. We call this latent TB.
Latent TB cannot be passed from person to person. The infection may remain in this state throughout your lifetime, but certain circumstances can encourage it to wake up or reactivate. This will make you unwell with active TB.
Sometimes people are screened for TB as part of a medical so your GP may refer you to the TB clinic for treatment of latent TB. This takes the form of medication for 3 months.
Contact tracing
You may be referred to the TB clinic because you have potentially been exposed to the TB germ. This might be because a family member, friend or colleague has TB and you have been identified as a contact.
The TB clinic appointment will follow the same format as described above in ‘Assessments and Tests at the TB clinic’, but may only involve a Tuberculin skin test or TB blood test, not a Chest X ray. The timing of these tests depends on the date of your exposure to TB so they may not be immediate.
It is important to understand that you should not turn down the opportunity to have TB screening because you have previously received a BCG immunisation and / or you are feeling well.
TB screening before biologic therapy
Your specialist may have requested TB screening ahead of you receiving biologic drugs for another condition (connected with gastroenterology, rheumatology, dermatology, neurology).
This is because biologic drugs suppress the immune system. Therefore, if you have latent TB, taking biologic medication might trigger the infection to reactivate and cause active TB.
If latent TB is discovered as part of your screening, you will be offered treatment for latent TB before starting biologic therapy. This screen will include Tuberculin skin test (in most cases), TB blood test, with or without a chest X-ray.
Support from the TB service
We want you to feel comfortable and informed at every step of care within the TB service. We welcome telephone enquiries and offer an open access service to our patients on treatment and undergoing investigation with us.
The TB Nurse Specialists work as part of a multidisciplinary team and manage the service with TB Respiratory Consultants.
Contact details for the TB clinic are at the bottom of this leaflet.
Contact information
Respiratory medicine
TB Clinic
8am to 4pm, Monday to Friday