Traveling abroad is often considered to be a life-changing experience. You come back with cherished souvenirs, priceless photos and extraordinary stories. But beyond the contents of your suitcase, you might unknowingly bring something else home: tuberculosis.
Kristen, a 32-year-old product-marketing manager at a San Francisco tech company, was always passionate about traveling and living an active lifestyle. In 2014, she and her husband decided to quit their jobs and see the world for six months. No plan, no itinerary, just adventure.
“We like cultural experiences," Kristen told SheKnows. "We ate street food, took long train rides through India, we went on treks — we had as much of an experience as we can. It was all great... until I found out I had TB.”
Actually, we’re not. While about one-third of the world population has some form of TB, it isn’t seen as a major threat in the United States. We get tested for exposure to TB as children (remember those two little needle pricks on your forearm?) but nothing is protecting people from the disease. It isn’t necessarily easy to catch, but certain factors do increase your chances of exposure — especially if you travel to a TB “high burden country.”
As it spreads through the air — like from a cough or sneeze — mycobacterium tuberculosis makes its way into your lungs. Here, it begins to grow slowly and in many cases quietly. For Kristen, these silent symptoms persisted for a year and half after her return home.
“As travelers, my husband and I are always calculated risk-takers,” Kristen explained. “We research necessary vaccines and follow state advice designed for people exposed to medical risks or dangerous political situations. We’re adventurous, but safe.”
The couple did their homework. It never once crossed her mind to get checked for TB.
In fact, it is rarely suggested that individuals get a TB test when they return to the United States, especially since the symptoms of TB aren’t always clear. Kristen did not feel ill; she didn’t have a cough or a fever. But she began to notice that she had some fluid in her lungs.
“I would sit up in the morning and I could hear my lungs drain, like the noises from an empty stomach,” Kristen said.
Time and time again, Kristen’s doctors assured her that she was just experiencing allergies. For eight months, she was simply sent home with Zyrtec, Flonase and saline solution — none of which got rid of the fluid filling her lungs. As a matter of fact, her symptoms were getting much worse: Kristen began to cough up blood. Afraid that her doctor would send her home with allergy medication for the umpteenth time, Kristen began documenting the blood with photos.
As the photos became darker and darker in color, Kristen finally got her doctor’s attention. She was immediately sent for X-rays and a panel of tests.
TB can be detected in your body in two forms: latent or active. In its latent form, your body has been exposed to the tuberculosis bacteria, and your immune system is successfully responding to it. You aren’t contagious, but the bacteria can progress to an active state at any time. In its active form, the bacteria have multiplied enough to suppress your immune system and can easily spread to others.
Given her extensive travel history, Kristen wasn’t surprised when her TB test came back positive for TB exposure. But her X-rays also showed a mild case of pneumonia. When they put the evidence together, her doctors realized that Kristen could have active TB. She was immediately advised to wear a mask and stay out of public spaces. With plans to fly to Hawaii the next day, Kristen began receiving urgent calls from the CDC threatening to place her on the Do Not Fly List unless she canceled her flight.
“There was zero urgency with this for eight months, and they didn’t even have confirmation of my diagnosis,” Kristen said. "I remember thinking, 'What do you mean, TB?'”
She soon completed the third piece of the diagnosis puzzle — a sputum test — and the skin cells from her lungs were found to contain active TB. Kristen was immediately handed over to the California Public Health Department; it was now illegal for her to put herself in public.
After confirming the presence of active TB in her lungs, Kristen began a strict routine of daily observed-therapy sessions at the California Public Health Department, where they monitored her as she took her medicine in isolation.
“My antibiotics were hard on my stomach and made me feel sicker than the TB,” Kristen recalls. “Really, an unpleasant experience.”
Kristen was forced into isolation within her home for eight weeks. She was only allowed to go outside in well-circulated areas with minimal human interaction. She continued to work with her clients, but only through video conference. Kristen was considered a major threat to public health.
“I couldn’t be around people besides my husband, I couldn’t walk to a grocery store, I couldn’t go in an ice cream shop, ” Kristen said. “I felt like a prisoner.”
As if the immense solitude and demanding medication wasn’t enough, the Public Health Department began to sit her down for interviews to try to figure out every single person she had been in contact with over the past three months. This meant that Kristen’s family, friends, and co-workers all had to be tested for TB; any chance of anonymity was thrown out the window.
“I had to be brave and be honest with everyone,” Kristen explained. “I had to say, ‘I’ve held your baby, I’ve been around you, friend-who-is-pregnant, mother-in-law-undergoing-chemo, and I may have gotten you really sick.' I’d ask them to cooperate with the Public Health Department.”
Maybe the CDC website outlined the physical symptoms of TB, but they surely never explained the emotional agony it caused Kristen.
After eight weeks of isolation and a total of nine months of antibiotics, Kristen returned to her normal life. Better yet, she continued to travel extensively despite the difficult diagnosis she once faced. Today, she wants to tell her story to spread much-needed awareness of TB. Her intentions aren’t to scare people from traveling. Rather, she wants everyone to embrace their passion of traveling and remain adventurous — and take a latent TB blood test when they get back home.
“If you’re exposed, it’s not a big deal,” Kristen said. “You get on antibiotics and get it taken care of before it becomes active.”
TB tests are quick and can be performed by your primary care physician and even at some local pharmacies. Kristen’s husband decided to get tested after her diagnosis. The results of the blood test came back positive for latent TB, but he caught it well before it could advance to an active state. After initiating a simple round of antibiotics, he was able to go to work and spend time in public without a quarantine period. His life didn’t have to change.
“Progressing to active TB is so invasive in every possible way, with every friend and every family member involved,” Kristen said. “It’s better to treat it in the beginning, and never let it get as bad as it did with me.”
If you find yourself abroad this summer or even just an area of high immigration and population, take advice from a fellow world traveler: Get the TB test. You won’t regret it.
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