Tuberculosis Hits Hard in Kansas City

State and local public health officials in Kansas are responding to a tuberculosis (TB) outbreak in the Kansas City area, where approximately 70 patients are being treated for active disease, according to a press release from the Kansas Department of Health and Environment’s (KDHE’s) Division of Public Health.

The KDHE and local health departments are following the Centers for Disease Control and Prevention (CDC) clinical guidelines to manage the TB patients and prevent additional spread, according to the press release.

“Following standard practice in infectious disease investigations, local health departments are working with each patient to identify possible close contacts and conduct TB testing at no cost,” according to the KDHE. Patients testing positive will be screened for active vs latent TB to determine treatment, which will be provided through the patient’s local health department.

The current outbreak in the Kansas City metro area is the largest documented outbreak in US history, since the 1950s, when the CDC began monitoring and reporting TB cases, said Jill Bronaugh, communications director for the KDHE, in an interview.

“The outbreak is still ongoing, which means that there could be more cases,” Bronaugh told Medscape. The Tuberculosis Outbreaks page on the KDHE website updates current case counts, she said.

Most of the cases in the current outbreak have occurred in a single county, Wyandotte County, where 60 individuals are currently being treated for confirmed active TB, Bronaugh said. Another seven active cases from the current outbreak are being treated in Johnson County. Cases related to the outbreak were first reported in January 2024, and include 79 confirmed latent TB cases, 77 in Wyandotte County and two in Johnson County, she said. To date, two reported TB deaths in 2024 have been associated with the current outbreak, she added.

In 2024, KDHE reported a total of 79 active and 213 latent TB cases, outbreak and non-outbreak related, across Wyandotte and Johnston counties, with the majority in Wyandotte, said Bronaugh.

The 2024 case counts are still provisional, and will be reviewed and confirmed by the CDC near the end of March 2025, Bronaugh told Medscape Medical News. “In 2023, the CDC recorded 46 active TB cases in Kansas,” she said. 

The risk to surrounding counties and the general public remains low, according to the KDHE press release; however, healthcare providers should have a high index of suspicion for TB when patients present with TB symptoms and risk factors.

According to the CDC, signs of active TB include cough, chest pain, and coughing up blood or phlegm. Additional symptoms depend on the area of the body that is affected. General symptoms of TB include fever, night sweats, weight loss, loss of appetite, and loss of energy. Symptoms specific to pulmonary TB include a lingering cough, especially one that lasts beyond 3 weeks, coughing up blood or phlegm, chest pain, and shortness of breath.

Risk Assessment, Case Management

“It is important for clinicians to be aware of this current situation in Kansas since it represents the largest TB outbreak in US history,” said Shirin A. Mazumder, MD, associate professor and infectious disease specialist at The University of Tennessee Health Science Center, Memphis, in an interview. 

“An active TB outbreak has major public health implications,” she said. Clinicians should know the symptoms of active TB disease, risk factors, and how to test, she added.

TB spreads when an individual with active disease coughs, sings or speaks, and is more likely to be spread in an indoor setting with poor air circulation where the bacteria linger longer in the air, Mazumder told Medscape Medical News.

Risk factors for TB exposure include travel to countries where TB is more common, such as regions in Africa, Asia, and Latin America, Mazumder said. “Spending time with someone who has active TB disease can also increase the risk of transmission. Other risk factors include exposure to congregate settings where TB may be more prevalent such as hospitals, homeless shelters, jails, and prisons,” she said. 

Immunocompromised individuals and the very young and old have a higher risk of developing active TB disease, Mazumder noted. “A combination of the presence of these risk factors in a community can play a role in an outbreak situation,” she said.

Treatment for TB can take up to 9 months and involves combinations of medicines depending on the patient’s medical history, according to the CDC. 

In cases of latent TB infection, an individual is exposed but does not develop signs or symptoms, Mazumder said. “Without treatment, some people with latent TB infection can develop active TB disease where they become ill,” she said. Immunocompromised individuals are at increased risk for active TB; they should be counseled about their risk and offered treatment for latent TB to reduce their risk of developing active disease, she added.

Mazumder had no financial conflicts to disclose.