to time." However, these symptoms do not guarantee tuberculosis, and they may not exist at all, yet the patient may still have active tuberculosis. A person with symptoms listed may have active tuberculosis, and the person should immediately see a physician so that tuberculosis is not spread. If a person with the above symptoms does not see a physician, ignoring the symptoms can result in lung damage, eye damage, organ damage and eventually death. When tuberculosis settles in other organs (rather than lungs) or other parts of the body (such as the skeletal), symptoms may be different from when it settles in the lungs (such as the symptoms listed above). Thus, without the cough or flu-like symptoms, a person can unwittingly have active tuberculosis. Other symptoms include back pain, flank pain, PID symptoms, confusion, coma, difficulty swallowing, and many other symptoms that would be a part of other diseases. (Please see the reference for more information on symptoms.) Therefore, seeing a physician and asking for a tuberculosis test is absolutely necessary to rule out tuberculosis when a patient has symptoms without a diagnosis of disease. Risk factors Situations in which tuberculosis may become reactivated are: if there is onset of a disease affecting the immune system (such as AIDS) or a disease whose treatment affects the immune system (such as chemotherapy in cancer or systemic steroids in asthma or Enbrel, Humira or Orencia in rheumatoid arthritis); malnutrition (which may be the result of illness or injury affecting the digestive system, or of a prolonged period of not eating, or disturbance in food availability such as famine, residence in refugee camp or concentration camp, or civil war); degradation of the immune system due to aging. certain systemic diseases such as diabetes, and "other conditions: debilitating disease (especially haematological and some solid cancers), long-term steroids, end-stage renal disease, silicosis and gastrectomy/jejuno-ileal bypass all confer an increased risk. "Elderly patients: latent TB may reactivate in elderly patients." young age. Diagnosis There are two classes of tests commonly used to identify patients with latent tuberculosis: tuberculin skin tests and IFN-γ (Interferon-gamma) tests. The skin tests currently include the following two: Mantoux test Heaf test IFN-γ tests include the following three: T-SPOT.TB QuantiFERON-TB Gold QuantiFERON-TB Gold In-Tube Tuberculin skin testing The tuberculin skin test (TST) in its first iteration, the Mantoux Test, was developed in 1908. Tuberculin (also called purified protein derivative or PPD) is