Active Tuberculosis (TB) Disease: For health professionals

• Active tuberculosis disease, also known as TB disease, is a condition in which Mycobacterium tuberculosis causes symptomatic disease and may present along a spectrum from mild or prolonged symptoms (e.g., cough ≥3 weeks) to severe symptoms (e.g., hemoptysis, fever, weight loss).
• Infection typically occurs in the lungs although other systems can be involved.
• All suspected or confirmed cases of active TB disease are reportable to Ottawa Public Health.

Symptoms of active TB disease may include:

• cough (especially if productive or bloody and/or associated with pain)
• fever
• weight loss
• fatigue
• night sweats
• lymphadenopathy
• pleural effusion
• abdominal, bone, and/or joint involvement, as these may be present concomitantly
• Please note that active TB disease may present as non-resolving pneumonia in children who have epidemiologic risk factors. Infants in particular, may present with non-specific symptoms resembling other infections. If the clinical syndrome does not resolve with regular therapy and there are concerns for active TB disease, a consultation with a pediatric ID specialist may be beneficial.

The risk factors for active TB disease include risk factors for latent TB infection (LTBI), also known as TB infection, as well as risk factors to progress from LTBI to active TB disease:

• Born, lived, or traveled in an area with a high burden of TB (including visiting friends and relatives)
  • Countries with a high burden of TB
  • Areas in Canada with a high burden of TB
• Prolonged and/or close contact with a person with active TB disease
• Individuals with certain medical comorbidities that increase the risk of developing tuberculosis disease, such as:
  • HIV infection
  • transplantation
  • chronic kidney disease (stage 4 to 5)
  • some cancers
  • treatment with tumour necrosis factor (TNF) inhibitors, or glucocorticoids equivalent to prednisone >= 15mg/day)
  • diabetes
  • silicosis
  • chronic renal failure 
  • Underweight (BMI < = 20)
• Individuals with environmental exposures that increase the risk of exposure to and development of tuberculosis disease, such as: homeless, under housed, or crowded living conditions
  • Use of injection drugs
  • Heavy use of alcohol
  • Smoking (tobacco, vapes, etc.)
  • Incarceration
  • Some health care settings as a health care workers

Diagnostic Work-up

• If you have a strong suspicion of active TB disease, please report to OPH before sending the patient for medical testing.
• Typically, pulmonary TB is diagnosed by chest imaging and sputum Acid-Fast Bacillus (AFB) smear, and culture.
  • Three sputum samples are collected at least one hour apart and sent to the Public Health Ontario Laboratories using Tuberculosis Kit order#: 390042
  • Complete a Public Health Ontario General Test Requisition for each sputum sample and write “TB Smear and Culture” on each requisition.
  • chest x-ray (anterior/posterior and lateral)

• If the patient does not have stable housing or is currently housed somewhere that may be inappropriate for isolation, please immediately notify OPH.

Active TB disease is reportable to Ottawa Public Health by the next business day:

• Monday to Friday from 8:30 am to 4:30 pm:
  • Fax 613-580-9640 or
  • Call 613-580-2424, extension 24224 and leave a detailed, confidential message including your contact information and contact information for the patient

For questions or if you are concerned about a patient who may have active TB disease and are looking for public health advice, please call 613-580-2424, extension 24224 and leave a detailed, confidential message including your contact information. The messages will be answered Monday to Friday from 8:30 am to 4:30 pm.

Please report any suspected cases of active TB disease to OPH before referring to a TB clinic.

Ottawa Public Health is involved with all individuals who have active TB disease in Ottawa. A Public Health Nurse will help with arranging the TB medications, medical appointments, and additional patient support during the TB treatment. A Public Health Nurse will also arrange for testing contacts (family, friends, or others) who have been exposed to the TB bacteria.

Ottawa Public Health is involved with all individuals who have active TB disease in Ottawa. A Public Health Nurse will help with arranging the TB medications, medical appointments, and additional patient support during the TB treatment. A Public Health Nurse will also arrange for testing contacts (family, friends, or others) who have been exposed to the TB bacteria.

Active TB disease is reportable to Ottawa Public Health by the next business day

• Monday to Friday from 8:30 am to 4:30 pm:
  • Fax 613-580-9640 or
  • Call 613-580-2424, extension 24224 and leave a detailed, confidential message including your contact information and contact information for the patient

For questions or if you are concerned about a patient who may have active TB and are looking for public health advice, please call 613-580-2424, extension 24224 and leave a detailed, confidential message including your contact information. The messages will be answered Monday to Friday from 8:30 am to 4:30 pm.

Tuberculosis, Ottawa Public Health

Self-Isolation handout, Ottawa Public Health

Treatment of active TB disease: Canadian TB Standards 8^th Edition.  Chapter 5: Treatment of tuberculosis disease

Pediatric TB: Canadian TB Standards 8^th Edition. Chapter 9: Pediatric tuberculosis

Provision of culturally safe TB care from the Canadian TB Standards 8^th Edition: Chapter 12: An introductory guide to tuberculosis care to improve cultural competence for health care workers and public health professionals serving Indigenous Peoples of Canada

Treatment of TB in individuals with medical comorbidities: Canadian TB Standards 8^th Edition. Chapter 10: Treatment of active tuberculosis in special populations