Five things to know about tuberculosis as it surfaces in Maine and North Carolina

Recent weeks have seen a handful of new Tuberculosis (TB) cases reported in states including Maine, North Carolina and California. While TB is rare in the U.S., even a single active case warrants attention. This article provides an overview of what TB is & how it spreads. TB is caused by a bacterium (Mycobacterium tuberculosis) that typically attacks the lungs, forming lesions called “tubercles,” and can destroy lung tissue — severe disease can lead to respiratory failure. There are two main forms: (1) Latent TB—not transmissible and often symptom-free; people may carry it for years without knowing.  (2) Active TB—infectious and symptomatic; the one public-health authorities worry about.  TB spreads via respiratory droplets (coughing, talking) — especially in crowded or poorly ventilated settings, like shelters, prisons, nursing homes, or other communal living/working environments. The following summarizes the risk factors and which populations are most vulnerable. People at greater risk include:
- Individuals with weakened immune systems (e.g., due to HIV, organ transplants, diabetes, substance abuse). 
- Residents or workers in group-living or group-working settings: homeless shelters, jails/prisons, nursing homes, hospitals, etc.
- Recent immigrants or travelers from regions where TB is more common globally — although U.S. residents traveling or exposed abroad can also bring TB into local communities. 
The following are symptoms, diagnosis and treatment information: 
- Common symptoms of active TB: persistent or progressing cough (often non-productive), shortness of breath, night sweats, unexplained weight loss, swollen lymph nodes. 
- Diagnosis involves a combination of methods: skin tests (TB exposure), blood/breath/sputum tests, and chest X-rays to confirm active infection. 
- TB is curable — but treatment is long: typically 6 months of antibiotics (initially a four-drug regimen for two months, followed by a two-drug course), and more severe cases can require up to nine months. 
- Proper treatment adherence is crucial: stopping early (because of side-effects or other reasons) can lead to persistent disease or antibiotic resistance.
- TB cases in the U.S. had been declining for decades (since 1993, when there were over 25,000 cases). 
Recently, though, there was a “blip upward”: cases rose 15.6% from 2022 to 2023, then climbed again into 2024. Encouragingly, for 2025 to date, preliminary figures show a decline: 5,310 cases among U.S. residents so far, compared with 6,227 at the same point last year. Still, experts note that “even a single active case is cause for concern,” given TB’s severity and treatability. 
Why this matters and what we should watch:
- Even though TB is less transmissible than flu or COVID-19, it remains serious — untreated, it can destroy lung tissue and cause death. 
- The reemergence, even if sporadic, of active cases in states like Maine and North Carolina suggests the need for vigilant public-health surveillance, rapid testing, robust contact tracing, and ensuring full adherence to long-term treatment.
- Vulnerable populations — people in congregate settings, those with weakened immunity, and individuals with global mobility — remain at higher risk.