One Teacher's Unexpected Diagnosis
Posted: December 20, 2018 | Word Count: 684
At the beginning of the school year in 2014, Laura Hall, a Spanish teacher from a town on Lake Champlain in Vermont, began experiencing an unrelenting cough that continued for months. After countless doctor visits and multiple false diagnoses — everything from allergies to influenza — Laura had lost nearly 20 pounds. Frustrated, tired and ill, but knowing something was terribly wrong, Laura took matters into her own hands and checked herself into the ER.
In the ER, Laura was finally diagnosed correctly with active tuberculosis, or TB. Without realizing it, she had been walking around with active TB for months, putting hundreds of students, colleagues, family and friends at risk of this airborne disease. According to Laura’s doctors, she most likely contracted TB while visiting family in Peru, though it is not clear how long the disease was living dormant in her body — meaning Laura may have been living with a latent TB infection (LTBI) for years, one that could have been treated long before it became active.
Many people consider TB a disease of the past, but it remains one of the most widespread, fatal infectious diseases worldwide, resulting in 1.3 million deaths a year. Approximately one-quarter of the world, including an estimated 13 million people in the U.S., are infected with LTBI, which has no symptoms and can progress to the highly contagious TB disease, particularly in those who are immunocompromised. Though only 10 percent of individuals infected with LTBI will go on to develop active TB, prevention of this life-threatening and contagious disease is essential. Given the silent symptoms of LTBI, people often aren’t diagnosed until it progresses to active disease.
Like most children who are born outside of the U.S., Laura was vaccinated for TB with the Bacillus Calmette–Guérin (BCG) vaccine as a child and was tested regularly throughout her career with the commonly used 100-year-old tuberculin skin test. However, the test never indicated Laura’s LTBI and she was never treated for it. If Laura had been accurately tested for LTBI, doctors may have been able to treat the infection before it progressed to the active, dangerous form of the disease.
“Most people do not understand the risk factors for TB progression, which is why latent TB infection often goes undiagnosed," said Dr. Lee Reichman, founding executive director of Global Tuberculosis Institute at Rutgers University. “Those at a heightened risk should talk with their doctors about being tested with the more accurate blood test rather than the skin test.”
Laura’s active TB forced her to be quarantined at home for months. Laura’s isolation and resulting panic in the community led to her constantly questioning, “Why did this happen to me?”
“I couldn’t go out, see friends and was unable to teach for five months while I was being treated,” Laura said. “It was incredibly isolating. I remember the panic that developed at my school and local community when the Vermont Department of Health required that 500 students and co-workers be tested for TB after my diagnosis.”
The Department of Health found 19 children and two adults positive for LTBI using QuantiFERON®-TB Gold, an advanced and accurate blood test for LTBI detection.
Today Laura does not want others to have the same experience, and she advocates for people to take control of their health by talking to their doctors about the risk factors of LTBI and about their testing options. By getting tested with a blood test, which yields results that are more accurate, objective and cost-effective than the older skin test, individuals who test positive for LTBI can begin treatment to stop the infection before it progresses to active disease.
If you or a family member think you may be living with latent TB, talk to your doctor about getting tested for latent TB — and request the accurate TB blood test.
The performance of the USA format of the QuantiFERON-TB Gold test has not been extensively evaluated with specimens from individuals younger than age 17 years, or in the immunocompromised population or in patients receiving immunosuppressive treatment or drugs.