Elementary school teacher Laura Hall figured that her lingering cough was a nasty cold. Then, doctors suggested it might be acid reflux or the flu. In reality, Laura was infected with tuberculosis (TB), a contagious lung ailment that remains one of the deadliest infectious diseases in the world.
Laura’s diagnosis eluded her health care team until it was almost too late. But, fortunately, intelligent diagnostics can help others avoid learning their lesson the hard way.
A Cough That Wouldn’t Quit
As an elementary school teacher, Laura is no stranger to sickness. Children are always battling one germ or another, and teachers are always exposed. But this time, Laura’s symptoms felt different.
Laura was constantly coughing, and none of her usual treatments seemed to be working. After receiving a series of different diagnoses coupled with rounds of antibiotics and other prescribed medications, Laura only grew sicker.
“I had the chills at night, my energy level was going down, and I kept losing weight,” Laura said. “I became more and more worried, because nobody could really help me.”
Laura reached a breaking point during the winter holidays, and she checked herself into the emergency room. Emergency doctors were able to give Laura the answer she’d been searching for, thanks to an innovative blood diagnostic: Laura had been battling tuberculosis, or TB, for months.
A Shock to the System
First, Laura was confused.
“It was absolutely shocking,” she said. “I kept asking, ‘Are you sure?’ I just couldn’t believe it, because I had not been near anybody with TB.”
Not to mention, Laura had been vaccinated against TB as a child, and was regularly tested with the commonly used TB skin test. The tests had always come back negative. Until her trip to the emergency room, Laura had never been given the more precise blood-based TB test.
The blood-based test mixes a patient’s blood with special protein fragments and measures the immune response to those fragments within the blood sample to determine whether the patient has TB. It is virtually painless and only takes one doctor’s visit. This blood-based test was the key that Laura’s doctors were missing.
Laura’s blood-based test revealed that she was carrying a latent TB infection (LTBI) – which is difficult to diagnose with a skin test alone – and had likely lived with it for years without trouble.
Unfortunately, Laura’s experience is far from unique. An estimated 13 million Americans and millions of others around the world carry LTBI. Even more troubling, patients with LTBI are often not diagnosed until their infection turns active, when they’re the most contagious. For Laura, the possibility that she had infected others – especially her students – was devastating.
“What worried me most was that I had worked at my school right up to the holidays,” she said.
Public health care officials immediately got to work to identify existing cases and prevent any new ones.
Recovery and a Recommendation
Laura spent four days in the hospital, and then returned home, where she was quarantined for three months. During that time, the Vermont Department of Health screened nearly 500 people who might have come into contact with Laura while she was contagious – including her family members, friends, coworkers, and, of course, her students. In total, twenty-one people were diagnosed with TB and all were treated successfully.
Still, Laura struggled with feelings of guilt.
“I felt ashamed and worried for my students,” she said. “I am so grateful that they all made me feel welcome again [at school] after my ordeal.”
Like any good teacher, Laura is determined to turn her experience into an educational tool. She hopes her story will encourage others to seek medical help when they need it and to consider being blood tested for TB.
“Anybody can get TB, so when that cough won’t go away, think about getting the test,” she said.
Already, health regulators are heeding Laura’s advice. In 2018, the World Health Organization (WHO) issued new, more detailed guidelines on latent TB screening, and the U.S. Centers for Disease Control and Prevention (CDC) has mandated the use of blood-based TB testing in specific scenarios, including during immigration health screenings.
Measures like these, in addition to holistic patient and provider education about the importance of blood-based TB testing, will help ensure that people with TB – especially latent TB – are treated before they get sick and put themselves and others at risk.
Laura was just one of the nearly 10,000 TB cases reported in the U.S. each year. Advanced medical technology – and smart policy promoting its use and access – can help bring that number down to zero.