Diagnosis: Tuberculosis

Tuberculosis (TB) is a serious infectious disease that mainly affects your lungs, but can be found in other organs of the body.

The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.

According to the World Health Organisation (WHO) South Africa is one of the countries with the highest burden of TB.

It is estimated that about 1% of our population of about 50 million develop active TB disease each year. This is worldwide the third-highest incidence of any country after India and China. It is estimated by WHO that about 60% of those infected have both HIV and TB infection.

In addition, there is now increasing resistance to some of the anti-TB drugs, making TB the leading cause of death in South Africa. And it discriminates on a socioeconomic basis, disproportionally affecting males, the poor, the young and nonwhite population groups.

It is also rampant in the mining industry, because workers are still exposed to silica dust, overcrowded hostel living, poor nutritional status and stress – all of which are major contributors to the development of TB. When workers become sick, they return to their families in rural areas and spread the disease.

Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacteria. Since the first antibiotics were used to fight tuberculosis more than 60 years ago, some TB germs have developed the ability to survive.

Some TB bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampicin. Resistance is mainly caused by not taking the medication as prescribed.

Are you at risk?

A healthy immune system protects you from being ill from contracting the TB bacteria. Any of the following conditions can weaken your immune system, or increase your risk:

• HIV/Aids, cancer, diabetes mellitus, severe kidney disease, being on medication for cancer or rheumatoid arthritis.
• Malnutrition and poverty.
• Being very young or very old.
• Living in poor overcrowded areas with poor access to ventilation and proper healthcare.
• IV drug abuse or alcohol abuse.
• Tobacco smoking has also been shown to increase risk.
• Healthcare workers regularly exposed to the bacteria.

Signs and symptoms

It is possible to have bacteria that cause tuberculosis in your body but not getting sick if your immune system is good. You can have what is called latent TB. It is also called inactive TB or TB infection, and it is not contagious.

Active TB makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later after having latent TB.

Signs and symptoms of active TB include:

• Coughing that lasts three or more weeks.
• Coughing up blood.
• Chest pain, or pain with breathing or coughing.
• Weight loss.
• Fatigue.
• Fever.
• Night sweats.
• Chills.
• Loss of appetite.

Tuberculosis can also affect other parts of your body, including your kidneys, joints, spine or brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs involved.

Tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine; when in the joints, you might have severely swollen painful joints, when in the brain you will have headache, fever and neck stiffness.

It is important that you see your doctor as soon as possible if you have two or more of the symptoms, especially if you are an at risk individual.

Treatment

Medication is the only way of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months.

The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, whether or not you are getting infected the first time, the form of TB (latent or active) and the infection’s location in the body. Studies are ongoing to find better ways of treating this infection.

Active tuberculosis, particularly if it’s a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include: Isoniazid; Rifampicin , Ethambutol; and Pyrazinamide.

If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as amikacin, kanamycin or capreomycin, are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.

A number of new drugs are being looked at as addon therapy to the current drugresistant combination treatment. I cannot overemphasise the importance of taking your treatment as prescribed and as long as prescribed. After a few weeks, you won’t be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs.

Stopping treatment too soon, or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat.

To help people stick to treatment, a programme called directly observed treatment (DOT) is recommended. In this approach, a healthcare worker administers your medication daily, so that you don’t have to remember.

Medication side-effects

Side-effects to medication do occur and can be dangerous. All tuberculosis medications can be highly toxic to your liver. When taking these medications, call your doctor immediately if you experience any of the following:

• Nausea or vomiting.
• Loss of appetite.
• A yellow colour to your skin (jaundice).
• Dark urine.
• A fever that lasts three or more days and has no obvious cause.

How you can prevent spreading the bacteria

Once you are diagnosed with active tuberculosis, it generally takes a few weeks of treatment with TB medications before you’re not contagious anymore. Follow these tips to help keep your friends and family from getting sick:

• Don’t go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis.
• Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn’t move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor air outside.
• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away.

Drug interactions

Significant and potentially dangerous interactions occur during TB treatment and principally involve the commonly used drugs being rifampicin, isoniazid and the fluoroquinolones. It is therefore very important that your doctor knows which other treatment you are on. These interactions can lead to treatment failure or liver damage.

The drugs interacting significantly with TB drugs include anticoagulants (blood thinners), anti-epilepsy drugs, antibiotics, cardiovascular therapeutics, contraceptives, steroids, HIV medication, asthma treatment, paracetamol (acetaminophen) and some food.

Old and immuno-compromised patients are particularly at risk of drug interactions during treatment. Among the latter, patients who are HIV-infected constitute the most important group.