Tuberculosis (TB) and Nontuberculosis Mycobacteria (NTM) Clinical Care

Tuberculosis (TB) is a bacterial (Mycobacterium tuberculosis) disease that primarily attacks the lungs, but can damage other body parts such as the bones, kidney, and brain.  More information about TB may be found on the Centers for Disease Control and Prevention (CDC) website.  TB cases may be classified as active (patient is currently infectious and can spread TB) or latent (patient has been exposed to TB, but is not currently able to spread the disease).

Nontuberculosis Mycobacteria (NTM) are disease-causing bacteria related to TB.  The most common bacteria causing NTM is Mycobacterium avium complex (MAC).  NTM are found in water and soil, but typically do not cause disease in healthy people.  However, NTM may cause disease in people with weakened immunity, such as those with cancer, HIV, and cystic fibrosis.  Others susceptible to NTM are people on chemotherapy or other medications that weaken a person’s immune system.

Primary symptoms for both TB and NTM include cough, shortness of breath, weight loss, night sweats, and fatigue.  Left untreated, TB and NTM may cause severe disease and death.

It is our goal to diagnosis and treat those with TB or NTM, while preventing spread to other people.

Baltimore City Residents

Our clinicians work closely with our colleagues in the Baltimore City Health Department (BCHD) to provide TB diagnosis and treatment.  Maunank Shah, MD, PhD is the Medical director of the BCHD TB program.

Other Maryland Residents

For Maryland state residents residing outside of Baltimore City, TB care, including DOT, is provided by the local health department. Sometimes private physicians will follow up with their private patients, but decisions regarding care are made by the local health department where the clinicians are very experienced with TB care.  The Maryland Center for Tuberculosis Control and Prevention provides consultation services to local health departments.

Residents from Other States

Residents from other states who travel to Johns Hopkins for consultation may be seen at our Infectious Diseases clinics at Greenspring or Johns Hopkins Bayview.  Treatment, DOT, and follow up take place through the person’s local health department.  In such cases, Johns Hopkins acts as a consultant, not the primary care provider.

International Residents Temporarily Residing in Baltimore City

For outpatient international residents who travel to Johns Hopkins in Baltimore for evaluation and treatment, TB management takes place through the Baltimore City Health Department.

Inpatient Consultation

For patients hospitalized in Johns Hopkins Hospital, the Infectious Diseases inpatient consultation team and Maunank Shah, MD, PhD coordinate care.  Inpatients are tracked through the Baltimore City Health Department for the duration of their stay within the City limits.

In Maryland, latent TB may or may not be evaluated and treated through the local health department.  Primary care clinicians may manage latent TB.  Care for latent TB may be provided through our Infectious Diseases Clinics at Greenspring or Johns Hopkins Bayview

Reportable Diseases

Active TB and Latent TB are reportable diseases in Maryland.  Active TB must be reported to the local health department.  Latent TB must be reported to the state health department.

Forms related to reporting, notifications, treatment records, and patient/provider agreements may be found on the website of the Maryland Department of Health, Center for Tuberculosis Control and Prevention.

Referring Clinicians

To refer patients for TB consultation, contact our Infectious Diseases clinics at Greenspring or Johns Hopkins Bayview.

Patients with NTM or bronchiectasis are seen at our multidisciplinary clinic located in the Johns Hopkins Bayview Asthma and Allergy Center.  This cooperative effort between Infectious Diseases and Pulmonary Medicine provides clinical care for individuals with pulmonary and extrapulmonary NTM, or bronchiectasis (airway scarring and chronic infection).  The clinic is staffed by clinicians and nurses offering comprehensive care to patients with these challenging diseases.  In addition, physical therapists are on hand to teach airway clearance techniques.  The clinic is held Fridays, 8 AM to 12 noon.
 

Referral Information

Physician referral is requested, although not mandatory, for patients with commercial insurance.  Managed Care/HMO patients must provide a consultation referral form prior to being scheduled for an appointment.  Please fax or mail referrals to the Referral Coordinator.  As soon as the referral is received, the Referral Coordinator will contact the patient to arrange an appointment.

Call 410-550-0546 and ask to speak to the NTM/Bronchiectasis coordinator or Fax 410-550-2612