• Posted July 16, 2025

Tuberculosis Is Back on the Rise: What To Know About Symptoms and Treatment

Tuberculosis (TB) was the leading cause of death in the United States in the 19th and 20th centuries. By 1900, TB — which usually attacks the lungs but can affect almost any part of the body — had killed 1 in 7 people who had ever lived, more than any other illness.

Fortunately, sanitoria, offering fresh air and isolation, significantly alleviated tuberculosis, or TB symptoms for many individuals during the first half of the 20th century. By the 1950s, antibiotics and other treatments had provided a cure that eliminated the disease in the United States. 

While the U.S. still has one of the lowest rates of tuberculosis in the world, thousands of people still contract the disease each year, with rates rising every year since 2021.2 In 2024, the U.S. Centers for Disease Control and Prevention (CDC) reported 10,347 cases in its provisional report, an 8% increase over 2023 and the highest number of new cases since 2011. 

Worldwide, more than 1.25 million people die from tuberculosis each year, and according to the World Health Organization, TB is the world’s leading cause of death from a single infectious agent, recently replacing COVID-19.

How is TB transmitted?

While tuberculosis is an airborne infection spread from person to person, it’s neither easy nor common to become infected.

Tuberculosis droplets are spread through the air when a person with active disease in their lungs or throat coughs, speaks or sings. These tiny droplets can stay in the air for several hours and are more likely to spread indoors than outdoors. While TB droplets can be inhaled through the air, they cannot spread simply by:

• Shaking hands

• Sharing food or drink

• Touching surfaces

• Sharing toothbrushes

• Kissing

Tuberculosis germs can settle in the lungs and become active or inactive TB. With active TB, the germs can grow and move through the bloodstream to other parts of the body. Not everyone infected with TB will become sick with an active disease.

People at highest risk for developing active TB disease are those with a weakened immune system, including: 

• Babies and young children

• People with chronic conditions, such as diabetes or kidney disease

• People with HIV infection

• Organ transplant recipients

• Cancer patients undergoing chemotherapy

• People receiving certain treatments for autoimmune disorders, (including rheumatoid arthritis or Crohn’s disease)

You also face a higher risk of contracting TB if you:

• Recently spent time with someone who has TB (such as a household contact)

• Traveled to a country where TB is common, including countries in Asia, Africa and Latin America

• Live in a group setting where TB is common, such as homeless shelters, prisons or jails

• Work in a hospital or healthcare facility where TB is likely to spread.

Inactive versus active TB

The tuberculosis bacteria Mycobacterium tuberculosis can live in the body for years without growing or making you sick. This is called inactive or latent TB. When TB germs multiply and grow in your body, it’s called active TB disease. Active tuberculosis is life-threatening; however, both inactive and active TB can almost always be treated and cured when medicine is taken as directed.

Someone with inactive TB:

• Has a small amount of live but inactive TB germs in their body

• Does not feel sick or have symptoms

• Cannot spread TB germs to others

• Should be considered for preventive or prophylactic treatment to prevent active TB disease

Someone with active TB (the inhaled germs are multiplying): 

• May have a bad cough that lasts more than three weeks, chest pain or cough up blood or mucus (sputum)

• Can spread TB to others

• Needs treatment as active TB can cause death without it

Other symptoms of active TB disease may include:

• Weakness or fatigue

• Loss of appetite

• Unintentional weight loss

• Fever

• Chills

• Night sweats

Diagnosing TB

If you believe you have been exposed to someone with TB, or you have symptoms of the disease, it’s important to make an appointment with your healthcare provider.

During your visit, your healthcare provider will likely:

• Collect your health care history.

• Ask about your symptoms and how and if you may have been exposed to TB. 

• Conduct a physical examination, using a stethoscope to listen to the lungs and check the lymph nodes in the neck for swelling. 

Your healthcare provider may also recommend a TB test — either a blood test or a skin test. For the skin test, you will need to return to your healthcare provider within 48 to 72 hours after the test is administered to measure the size of the bump or reaction from the injection site.

If your blood or skin tests come back positive for TB, your provider may conduct other tests, such as a chest X-ray or a test of your sputum (the mucus when you cough) for bacteria.

Before receiving a TB test, it’s important to tell your healthcare provider if you have had the Bacille-Calmette-Guérin (BCG) vaccine, a vaccine for tuberculosis disease The BCG  vaccine, which is not generally administered in the U.S., can cause a false positive TB skin test reaction.

Treatment for TB

A treatment plan for inactive or active disease typically consists of a schedule of TB medications. Tuberculosis germs grow in a manner that requires a long treatment regimen to effectively cure the disease, and for that reason, it’s important to take all medicines as directed.

Your healthcare provider will discuss the following information about your treatment plan:

• Types of medication

• Amount of medication

• Recommended period to take the medication

• Possible side effects of the medication

With inactive TB, treatment can take three to nine months and may include a combination of medications, including Isoniazid, Rifampin and Rifapentine. Active TB may take four to nine months to treat and may include a combination of Ethambutol, Isoniazid, Moxifloxacin, Rifampin, Rifapentine and Pyrazinamide.

Some TB germs are resistant to medicine. This includes instances when medications were not taken exactly as prescribed. Individuals with drug-resistant TB should see a physician, such as a pulmonologist or infectious disease specialist, with experience treating this complicated disease.

Your primary care physician or local public health department can help you identify an appropriate physician.

Preventing the spread of TB

If you have active TB, it will take a few weeks of treatment before you are no longer able to spread the disease to others. Until your healthcare provider tells you to go back to your daily routine, here are ways to protect yourself and others near you.

• Take your medicine exactly as the healthcare provider directed.

• Cover your mouth with a tissue when you cough, sneeze or laugh, and then place the tissue in a closed bag and throw it away.

• Do not go to work or school until your healthcare provider says it's OK to do so.

• Avoid close contact with anyone. This includes while you are sleeping.

• Air out your room often so the TB germs don't stay in the room and infect someone else.

• If you must interact with healthcare or other individuals, an N95 respirator mask that fits over the nose and mouth can reduce the risk of transmission.

Keeping you and your family healthy

Most people in the United States face a minimal risk of contracting TB. However, with the number of cases rising, it’s important to be aware of symptoms, understand the risk factors and situations that may increase your susceptibility to this disease, and know the steps to take if you have symptoms to keep you and your family healthy.

If you are traveling internationally, check to see if tuberculosis is common in the countries you plan to visit. You may also want to get tested for TB before and after your trip.

About the expert

Dr. Albert A. Rizzo is Chief Medical Officer for the American Lung Association and the organization's senior medical authority. Dr. Rizzo has long been a key medical advisor to the American Lung Association, a member of the Lung Cancer Expert Medical Advisory Panel and a leading media spokesperson for the Association. He is board certified in internal medicine, pulmonary, critical care and sleep medicine and is a clinical assistant professor of medicine at Thomas Jefferson University Medical School in Philadelphia where he obtained his medical degree and completed his residency in internal medicine. Dr. Rizzo received his specialty training at Georgetown University Hospital in Washington, D.C.