What to Know About Tuberculosis

In some parts of the United States — including California — tuberculosis (TB) shows up more often than in other regions. While it’s not something most people think about day to day, it’s still circulating, and understanding the basics can help you recognize when something isn’t quite right.

Daniel Shin, M.D., an infectious disease doctor with Sutter, is dedicated to educating communities about what tuberculosis is, how it spreads and what to know about symptoms, screening and treatment. 

What Is Tuberculosis?

Tuberculosis gets its name from Mycobacterium tuberculosis, the bacteria that causes the condition. It’s typically spread through the air when someone who has active tuberculosis sneezes, coughs, sings, etc. Most cases are passed person to person, though one type can come from cows and generally affects farmers or ranchers.

Symptoms can develop gradually and may include:

• Chest pain or pain when breathing or coughing
• Cough (sometimes with blood or mucus)
• Fatigue
• Fever or chills
• Loss of appetite
• Night sweats
• Unexplained weight loss

Some of these symptoms can overlap with more common illnesses like the flu. Tuberculosis is different in that it comes on more slowly and lingers a lot longer.  

“Most people recover from a typical cough within a couple of weeks, but tuberculosis is different,” Shin says. “Patients may say they’ve been coughing for months.”

That lingering cough can be an important signal that something more is going on. 

Tuberculosis in the U.S.

Tuberculosis is always circulating in the United States. During the COVID-19 pandemic, cases declined, probably due to social distancing practices and delays in screening. In the years that followed, cases increased again before beginning to level off.

Some states, including California, Texas and New York, tend to report higher numbers of cases. This doesn’t necessarily mean there are outbreaks. Instead, it often reflects population patterns.

“Here in Santa Clara County, most of our patients with active tuberculosis were born outside the U.S.,” Shin says.

This reflects global differences in TB rates rather than local transmission alone. 

Tuberculosis Prevention

Preventing tuberculosis can be challenging because exposure isn’t always obvious. That’s why screening plays an important role, especially for people who may be at higher risk.

Testing is typically done through a blood test or a skin test. In some regions, screening is more common than in others. For example, students and people living or working in group settings — such as nursing homes or correctional facilities — are often tested.

“I often recommend testing for latent tuberculosis,” Shin says. “That means the bacteria is in the body, but it hasn’t caused illness.”

Identifying TB at this stage allows for treatment before symptoms develop, which can help prevent the disease from becoming active.

How Tuberculosis Is Treated

Tuberculosis is treated with antibiotics. The approach depends on whether the infection is latent or active.

Latent tuberculosis means the bacteria is present but not causing symptoms. Treatment at this stage is usually simpler and shorter.

“If the test is positive, we typically follow up with a chest X-ray to check the lungs,” Shin says. “If everything looks normal, we can treat latent TB before it becomes more serious.”

Active tuberculosis is also treatable but usually requires a longer course of medication and closer monitoring.

When Symptoms Mean Something Else

Symptoms like a persistent cough, fatigue or weight loss can have several causes. Conditions such as fungal infections, including valley fever, or even lung-related conditions may present in similar ways.

“If someone has been coughing for a few months and has other symptoms like weight loss, we look more closely,” Shin says. “That might include imaging or additional tests to understand what’s going on.”

If something doesn’t feel right — especially if a cough lingers longer than expected — it may be worth checking in with your provider.

Understanding your risk and staying aware of changes in your health can help you take the next step with confidence.