Tuberculosis remains a big problem in South Africa

World Tuberculosis (TB) Day was on 24 March. The day builds public awareness that TB remains an epidemic in much of the world, causing the deaths of several million people each year, mostly in third-world countries.

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 it are spread 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 60 million develop active TB each year – the third highest in the world after India and China.

It is estimated by WHO that about 60% of those infected have both HIV and TB.

In addition there is now increasing resistance to some of the anti-TB drugs, making it the leading cause of death in South Africa.

Its incidence is based on socio-economic status, disproportionally affecting males, the poor, the young and non-white population groups.

It is also rampant in the mining industry, because workers are still exposed to silica dust, overcrowded hostel living, poor nutrition and stress, all of which are major contributors to the development of TB.

When people get sick, they return to their families in rural areas and spread. Another reason TB remains a major killer is the increase in drug-resistant strains.

Since the first antibiotics were used to fight TB more than 60 years ago, some of its germs have developed the ability to survive, and that ability gets passed on to descendants.

Some TB bacteria have developed resistance to the most commonly used treatments, such as isoniazid and rifampicin.

Resistance is mainly caused by the patient not taking the medication as prescribed.

Signs and symptoms

It is possible to have bacteria that cause tuberculosis but not get sick – known as latent TB, inactive TB or TB infection.

This type is not contagious. Active TB makes you sick and can spread to others.

Signs and symptoms:

• Coughing that lasts three or more weeks.
• Coughing up blood.
• Chest pain, pain 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.

Treatment

Medication is the only way to treat TB.

Treatment takes much longer than treating other types of bacterial infections – six to nine months. 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. T

he most common medications include: isoniazid, rifampicin, ethambutol and pyrazinamide.

If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as a mikacin , kanamycin or capreomycin, are generally used for 20 to 30 months.

Some types of TB are resistant to these medications as well. I cannot over-emphasise the importance of taking treatment as prescribed for as long as prescribed.

After a few weeks, you won’t be contagious and 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 with their treatment, a programme called directly observed treatment is recommended.

A healthcare worker administers medication daily. That requires that the patient to present to the clinic daily.

Medication side-effects

Side-effects do occur and can be dangerous. All TB 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.

Prevent spreading the bacteria

• Don’t go to work or school or sleep in a room with other people during the first few weeks.
• Ventilate the room.
• Cover your mouth. Use a tissue to cover your mouth anytime you laugh, sneeze or cough.