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Tuberculosis (TB)

TB is such a prevalent infectious disease for South Africans to be aware of. Why? Because it has topped the the leading causes of death in SA from 2016 to 2018. In 2020, the WHO estimated 61 000 deaths due to TB in SA, with numbers increasing by 5% from 2019 due to lack of diagnosis and access to healthcare during COVID lockdowns. It's incorrectly regarded as an illness of the poverty stricken or immunocompromised, as TB presents in any and everyone- from the local taxi driver to the suburban housewife.

How is TB spread?

TB is spread via respiratory droplets I.e coughing or sneezing. The chances of getting TB are higher when people are in an enclosed space together, where one person is infected with TB. For example in an office space or a bus.

What are the common signs and symptoms of TB?

  • Loss of appetite

  • Loss of weight (usually 5-10% of baseline body weight)

  • Fevers- especially night sweats that drench your sheets

  • Cough- can be wet or dry

  • Chest pain

  • General fatigue

TB doesn’t always classically present with a cough so if you’ve lost a substantial amount of weight and you have fevers or sweats, your doctor or nurse should consider TB as a potential diagnosis.

How does one diagnose TB?

TB is most commonly diagnosed by running a test called a GeneXpert, which looks for TB DNA in your sputum (phlegm that you cough up). A chest XRAY also assists in diagnosing TB and can tell us whether there are any complications related to TB and the extent of destruction it has caused in the lungs. There are other tests that can be done- an ultrasound to look for TB in the abdomen or a lumbar puncture/ MRI that looks for TB in the spine. That’s the scary thing about TB, it can be found in many systems or organs in the body and can spread easily if left untreated.

How do you treat TB?

Well firstly it depends on whether the TB is sensitive to the conventional drug therapy. If so, TB in the lung is treated for 6 months and TB in other parts of the body between 9 and 12 months.

Complications arise when TB is multi drug resistant (MDR) or Extensively drug resistant (XDR). Additional drugs are used and treatment lasts for a longer period. Treatment success rates are much lower in these categories, which is why we are working hard to curb the TB epidemic in SA to prevent further drug resistance from developing.

Are there long term consequences of getting TB?

Unfortunately yes there can be. If treated, TB can still cause irreversible damage to your underlying lung architecture, which can predispose you to recurrent chest infections and TB again. If untreated, complications are worse. When spread to other organs occurs, you may end up with life threatening complications such as inflammation of the lining of the heart or liver dysfunction.

What can I do to stop the spread of TB?

  • If you test positive for TB, start treatment and stay home and isolate for 2 weeks. Only after repeating a sputum test that shows you have no active TB in your sputum can you return to work/ mix with others.

  • BCG vaccination for children at birth

  • Keep windows open/ have good air circulation in places where people work in close proximity with each other, especially those in the healthcare sector.

  • Patients who are immunocompromised I.e pregnant women , the elderly, children, patients with HIV or cancer should have a high index of suspicion when they experience the above symptoms and should test and be on treatment as soon as possible to prevent poor outcomes.

The COVID pandemic has definitely shifted our focus off TB. Prior to the COVID-19 pandemic, many countries were making steady progress in tackling TB, with a 9% reduction in new TB cases seen between 2015 and 2019 and a 14% drop in deaths in the same period. The WHO End TB Strategy aims for a 90 per cent reduction in TB deaths and an 80 per cent reduction in the TB incidence (new case ) rate by 2030, compared to the 2015 baseline. Educating and empowering people through knowledge about TB is what’s going to help us get closer to this goal as a country.

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