Tuberculosis (TB) is a bacterial disease that mainly affects the lungs. In 15% of patients it affects other areas, causing swollen lymph nodes, pleurisy (inflammation of the membranes around the lungs), and meningitis (inflammation of the inner membranes of the brain and spinal cord). It may also affect the kidneys, urinary tract, genitals, thyroid, bones, and joints. TB in the lungs or throat is the most infectious form. In 1993 the World Health Organization called tuberculosis a "global emergency," with an estimated 8 million new cases of tuberculosis each year. Before the discovery of certain antibiotic drugs in the 1940s, TB was the leading cause of death in the United States. Even though there has been an effective public health campaign to stem the tide of rising tuberculosis rates since 1993, it remains one of the most serious public health challenges.

Signs and Symptoms

Usually there is a time delay between infection and the development of full-blown TB. Many who are infected with TB never develop the disease. In some people it is possible for the TB bacteria to remain inactive for a lifetime without ever causing disease. But in others, especially those with weakened immune systems, the bacteria become active. It is also common for those who are infected to be asymptomatic (without symptoms) for several months to years. For example, children are more likely than adults to have no symptoms or to show symptoms in other parts of the body besides the lungs. The type of symptoms will depend on where in the body the TB bacteria are growing. Typically, TB bacteria that grow in the lungs may cause:

What Causes It?

Mycobacterium tuberculosis causes most cases of TB. This bacterium only lives in humans. Two other bacteria cause TB. They are M. bovis and M. africanum. M. bovis is transmitted by milk from infected cows. This strain of TB is rare, however, because milk is now regularly pasteurized. M. africanum is also rare and occurs primarily in Africa. Those already infected with M. tuberculosis, M. bovis, or M. africanum are most likely to develop active TB within two years of exposure.

TB is spread from one person to another through airborne bacteria. Typically what happens is that a person with TB in the lungs or the throat coughs or sneezes; then, others nearby breathe in the bacteria. When a person breathes in TB bacteria, the bacteria can settle into the lungs and begin to grow.

Who's Most At Risk?

Because TB is only spread through inhalation of infected respiratory particles in the air (see section entitled What Causes It?), you are not likely to contract the infection through other means such as handshakes or sharing of dishes and utensils. Another important fact to remember is that people with TB are most likely to spread it to people with whom they spend the most time—family members, friends, classmates, and coworkers. Those at risk for developing TB include:

What to Expect at Your Provider's Office

If you are infected with TB, you should expect a healthcare provider to perform an exam and ask about symptoms. He or she will use a stethoscope to pick up unusual breathing sounds, such as bubbling or crackling noises when you inhale after a cough or a hollow blowing sound when you breathe. These may indicate lung-related disease, but your healthcare provider will need to do other tests specifically for TB. A skin test and tests of sputum (mucus and other material coughed up from the lungs) or of fluid or tissue samples may also confirm infection with TB-causing bacteria. Finally, a chest X ray may show signs of TB in the lungs.

Treatment Options


From a public health perspective, the most important way to keep TB from spreading is for infected persons to take their medications exactly as prescribed. If you have TB, keeping all your clinic appointments is essential so that the doctor can check for side effects from the drugs and check the effectiveness of the treatment. If you are sick enough with TB to go to a hospital, you may be put in a special room with air vents that keep the TB bacteria from spreading. You will most likely be prevented from leaving your room and people who come into the room will wear special face masks to protect themselves from TB bacteria and to prevent the spread of TB bacteria to others.

Treatment Plan

If suspicious of TB, healthcare providers may begin treatment before all lab tests return, including prescribing more than one anti-TB drug. Emergency treatment may be necessary if, for example, you are coughing up blood.

Drug Therapies

TB bacteria die very slowly. It takes at least 6 months for the medicine to destroy all of the TB bacteria. If you have TB, you will need to take several different drugs, usually for six to nine months. Treatment lasts longer for those who have HIV or have active TB outside of the lungs. You will be tested first for drug resistance to determine the most effective combination of drugs to prevent the bacteria from becoming resistant to the drugs. The most common drugs used to fight TB are:

Surgical Procedures

Surgery may be needed to repair bone and joint problems caused by TB that has spread to those areas.

Complementary and Alternative Therapies

While it is tempting to think that establishing good nutrition may restore damaged immune function or that dietary supplements may prevent TB infection, effective control of TB depends on appropriate use of medications. Researchers continue, however, to investigate the potential of vitamins and herbs to combat TB.

Patients at risk for vitamin deficiency (malnourished, alcoholics, elderly, pregnant and nursing mothers) or for nerve degeneration (those with diabetes, HIV, or chronic kidney failure) may need vitamin B6. In addition, recent studies have suggested that a diet lacking in certain nutrients may be linked to abnormalities in immune function, resulting in a poor response to TB and to the BCG vaccine, especially among the elderly, children, alcoholics, the homeless, and HIV-infected individuals. These nutrients include: Animal studies suggest that TB may be more severe in persons with diets rich in omega-3 essential fatty acids compared to those rich in omega-6 essential fatty acids. The omega-3 fatty acids appeared to impair the animals' immune systems, diminishing the ability to kill certain organisms including M. tuberculosis. While it is unclear how this animal study will translate to humans, it may be wise to avoid foods rich in omega-3 fatty acids if you have tuberculosis.

Herbs The antibacterial properties of garlic are fairly well documented. In vitro studies have demonstrated that garlic extract inhibits the growth of many species of bacteria. However, high concentrations of garlic extract were needed to slow down the growth of M. tuberculosis. Such high levels could prove toxic to humans. While further study is needed, a recent animal study indicated that garlic oil (which is a higher concentration than the extract) also inhibited M. tuberculosis, reducing TB lesions. A combination of garlic extract or garlic oil with anti-TB drugs may eventually prove effective against the disease.

Other herbs that may be helpful include: Homeopathy
There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for tuberculosis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Prognosis/Possible Complications

A full course of medication can cure TB in those who do not have a drug-resistant strain. The outcome may be less promising in patients who are elderly, those who have TB that has spread to locations other than the lungs including miliary TB (which spreads through the bloodstream affecting many organ systems), drug-resistant strains of TB, or those with HIV.

Possible complications of TB include:

Following Up

U.S. public health policy requires healthcare providers to report cases of TB and to treat or quarantine all patients. Most patients may remain at home, but all should be kept from any new contacts for at least two weeks after treatment begins. The elderly and those who are acutely ill or have drug-resistant TB should be hospitalized for at least the first few days of treatment.

It is essential to take all TB medication exactly as prescribed in order to cure TB and prevent drug resistance. Any adverse drug reactions should be reported to your healthcare provider right away. Sputum samples are collected and tested monthly. If tests are still positive after three months of treatment, the infection is considered drug resistant and a change in medications is in order.

Special Considerations

Treating TB does require common sense in minimizing the spread of the disease to yourself and to others as well as communication and cooperation with your healthcare provider. Since the effective treatment of TB depends on the use of multiple antibiotic drugs for an extended period of time, it is essential that you consult with your healthcare provider before pursuing any complementary or alternative therapies, including taking herbs and vitamin supplements.


Abul HT, Abul AT, Al-Althary EA, Behbehani AE, Khadadah ME, Dashti HM. Interleukin-1 alpha (IL-1 alpha) production by alveolar macrophages in patients with acute lung diseases: the influence of zinc supplementation. Mol Cell Biochem. 1995;146(2):139-145.

Agrons GA, Markowitz RI, Kramer SS. Pulmonary tuberculosis in children. Semin Roentgenol. 1993;28(2):158-172.

Barry CE. New horizons in the treatment of tuberculosis. Biochem Pharmacol. 1997;54(11):1165-1172.

Bastian I, Colebunders R. Treatment and prevention of multidrug-resistant tuberculosis. Drugs. 1999;58(4):633-661.

Bednall R, Dean G, Bateman N. Directly observed therapy for the treatment of tuberculosis—evidenced based dosage guidelines. Respir Med. 1999;93(11):759-762.

Cantrell CL, Abate L, Fronczek FR, Franzblau SG, Quijano L, Fischer NH. Antimycobacterial eudesmanolides from Inula helenium and Rudbeckia subtomentosa. Planta Med. 1999;65(4):351-355.

Ciprofloxacin. NMIHI. Accessed at on October 11, 2018.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders; 1996.

Chanarin I, Stephenson E. Vegetarian diet and cobalamin deficiency: their association with tuberculosis. J Clin Pathol. 1998;41(7):759-762.

Chaulk CP, Kazandjian VA. Directly observed therapy for treatment completion of pulmonary tuberculosis: Consensus statement of the Public Health Tuberculosis Guidelines Panel. JAMA. 1998;279(12):943-948.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 79, 320-321.

Curtis AB, Ridzon R, Vogel R, et al. Extensive transmission of Mycobacterium tuberculosis from a child. N Engl J Med. 1999;341(20):1491-1495.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

Delaha EC, Garagusi VF. Inhibition of mycobacteria by garlic extract (Allium sativum). Antimicrob Agents Chemother. 1985;27(4):485-486.

Disseminated Tuberculosis. Ada Health. Accessed at on October 11, 2018.

Douglas JG, McLeod MJ. Pharmacokinetic factors in the modern drug treatment of tuberculosis. Clin Pharmacokinet. 1999;37(2):127-146.

Elder NC. Extrapulmonary tuberculosis. A review. Arch Fam Med. 1992;1(1):91-98.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Gillespie SH, Kennedy N. Fluoroquinolones: a new treatment for tuberculosis? Int J Tuberc Lung Dis. 1998;2(4):265-271.

Grassi C, Peona V. Use of rifabutin in the treatment of pulmonary tuberculosis. Clin Infect Dis. 1996;22(suppl 1):S50-S54.

Hanekom WA, Potgieter S, Hughes EJ, Malan H, Kessow G, Hussey GD. Vitamin A status and therapy in childhood pulmonary tuberculosis. J Pediatr. 1997;131(6):925-927.

Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med. 1999;340(5):367-373.

Hirsch CS, Johnson JL, Ellner JJ. Pulmonary tuberculosis. Curr Opin Pulm Med. 1999;5(3):143-150.

Jain RC. Anti tubercular activity of garlic oil [letter]. Indian J Pathol Microbiol. 1998;41(1):131.

Jana N, Vasishta K, Saha SC, Ghosh K. Obstetrical outcomes among women with extrapulmonary tuberculosis. N Engl J Med. 1999;341(9):645-649.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 256.

Levofloxacin. NMIHI. Accessed at on October 11, 2018.

Mbala L, Matendo R, Nkailu R. Is vitamin B6 supplementation of isoniazid therapy useful in childhood tuberculosis? Trop Doct. 1998;28(2):103-104.

McMurray DN, Bartow RA, Mintzer CL, Hernandez-Frontera E. Micronutrient status and immune function in tuberculosis. Ann NY Acad Sci. 1990;587:59-69.

Medications for Tuberculosis. Accessed at on October 11, 2018.

Nakamura T, Shiraishi N, Aono K. Effects of in vitro and in vivo supplementation with zinc on superoxide anion production in leukocytes. Physiol Chem Phys Med NMR 1987;19(3):147-151.

Newton SM, Lau C, Wright CW. A review of antimycobacterial natural products. Phytother Res. 2000;14(5):303-322.

Pablos-Mendez A, Raviglione MC, Laszlo A, et al. Global surveillance for antituberculosis-drug resistance, 1994–1997. N Engl J Med. 1998;338(23):1641-1649.

Paul KP, Leichsenring M, Pfisterer M, et al. Influence of n-6 and n-3 polyunsaturated fatty acids on the resistance to experimental tuberculosis. Metabolism. 1997;46(6):619-624.

Petersen L, Mommsen S, Pallisgaard G. Male genitourinary tuberculosis. Report of 12 cases and review of the literature. Scand J Urol Nephrol. 1993;27(3):425-428.

Prednisone. NMIHI. Accessed at on October 11, 2018.

Rakel RE, ed. Conn's Current Therapy. 51st ed. Philadelphia, Pa: W.B. Saunders; 1999.

Ramadan HH, Tarazi AE, Baroudy FM. Laryngeal tuberculosis: presentation of 16 cases and review of the literature. J Otolaryngol. 1993;22(1):39-41.

Rastogi N, David HL. Mechanisms of pathogenicity in mycobacteria. Biochimie. 1988;70(8):1101-1120.

Reese RE, Betts RF, eds. Practical Approach to Infectious Diseases. 4th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996.

Rook GA, Steele J, Fraher L, et al. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology. 1986;57(1):159-163.

Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Sass P. Tuberculosis infection and disease in children. Am Fam Physician. 1996;53(6):2087-2094.

Starke JR. Tuberculosis of the central nervous system in children. Semin Pediatr Neurol. 1999;6(4):318-331.

Tan KK. Tuberculosis of the thyroid gland—a review. Ann Acad Med Singapore. 1993;22(4):580-582.

Tuberculosis. NMIHI. Accessed at on October 11, 2018.

Tuberculosis (TB). WebMD. Accessed at on October 11, 2018.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 151-154, 163-164.

van Rie A, Warren R, Richardson M, et al. Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. 1999;341(16):1174-1179.

Wagner H, ed. Immunomodulatory Agents From Plants: Progress in Inflammation Research. Boston, Mass: Birkhauser Verlag; 1999:123-124, 294-297.

What is TB? MedlinePlus. Accessed at on October 11, 2018.

Wilkinson D. Drugs for preventing tuberculosis in HIV infected persons. Cochrane Database Syst Rev 2000;No. 2:CD000171.

Wilkinson RJ, Llewelyn M, Toossi Z, et al. Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study. Lancet. 2000;355(9204):618-621.