Tuberculosis: the silent killer

by Tshepy Matloga-Malope
lung health, where the breath of life flows freely, nourishing vitality and well-being
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Tuberculosis (TB), a disease caused by the bacterium Mycobacterium tuberculosis, primarily affects the lungs, but it can also target other parts of the body such as the abdomen, spine, and brain. In South Africa the estimate is that about 304 000 people fall ill with TB each year. By Tshepy Matloga-Malope

In 2022, 54 200 people died of TB in South Africa—or one person every 10 minutes. Between 2015 and 2022, the TB death rate in the country has fallen by only 17%. A further 73% reduction (from 2015 rates) must be achieved in the remaining years until 2030 for South Africa to meet global SDG (Sustainable Development Goals) targets

How does it spread?

Classified as an airborne disease, tuberculosis spreads through the air when an infected individual coughs, sneezes, or speaks, making it highly contagious.We often suspect TB if you stay with or have been in contact with someone who is sick with TB,” says Dr Ntokozo Mzimela, lecturer of Integrated Pathology–Microbiology and Virology pathology at Nelson Mandela University.

Understanding the risk factors, treatments, and preventive measures associated with tuberculosis is crucial in combating this age-old disease.

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Risk Factors for TB

Several factors can increase the risk of developing tuberculosis. People with weakened immune systems, especially those with HIV, are more susceptible to tuberculosis. TB and HIV coinfection have a perilous synergy with each disease accelerating the other’s progression. Therefore, there is increased risk of complications as both diseases weaken the immune system.

“Treatment strategies for individuals with TB and HIV often involve coordinated care to manage both conditions effectively. Close monitoring, adherence to treatment regimens and addressing drug interactions are essential in managing TB-HIV co-infection. We don’t start TB treatment and HIV at the same time as this may worsen disease state of the sick person”, says Dr Mzimela. Plus, individuals who have close contact with someone who has active tuberculosis are at higher risk of infection.

Signs of TB

Symptoms of tuberculosis vary depending on whether the infection is active or latent. In active tuberculosis, patients may experience:

  • Persistent coughing
  • Chest pain
  • Coughing up blood
  • Weight loss
  • Fatigue
  • Fever
  • Night sweats

 On the other hand, latent tuberculosis usually has no symptoms, but the bacteria remain dormant in the body and can become active at a later stage if the immune system weakens. Latent TB infection refers to a state where M. tuberculosis bacteria are present in the body but do not show symptoms. However, when immune system weakens such as in HIV, these bacteria can reactivate leading to active TB disease where patient presents with TB symptoms.

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lung health, where the breath of life flows freely, nourishing vitality and well-being

Treatments for TB

There are first line drugs for sensitive TB. This drug combination has four drugs called Rifafour and this treatment full course is taken for 6 months. Second line option of drugs for drug resistant TB varies. “We have 6-months, 9 months, and 18 months regimens. The 6-months regimens known as BPaL and BPaL-L was introduced in 2023.

“The 6-months regimen is shorter and is taken orally in pill form. The other regimens are long and individualised, they include injectables for a specific period followed by oral medication in pill form to complete full course of treatment” says Dr Mzimela.

It is essential to complete the full course of treatment to ensure that all bacteria are killed and to prevent drug resistance from developing.

Drug resistant strains emerge due to interruption of treatment or improper treatment leading bacteria to mutate and develop resistance against the drugs. “Significant research is being done with newer drugs like Bedaquiline and Delamanid that show promise for managing drug resistant TB as we now have a shorter 6-months regimen that is tablets only” says Dr Mzimela.  Research efforts are also focused on developing diagnostic tools so as to be able to diagnose quicker and treat promptly to prevent spread of TB including drug resistant TB.

 How to prevent TB

Preventing tuberculosis involves a combination of vaccination, infection control measures, and public health strategies.  “We currently have a TB vaccine called BCG given at birth that prevents disseminated TB in children however it has limitations in preventing pulmonary TB in adults” says Mzimela. Researchers are working on developing new vaccine candidates, but breakthroughs have been limited.

According to Dr Mzimela, there is hope that with advancements in molecular biology, immunology and genetic sequencing, we may be closer to a significant breakthrough. In addition to vaccination, improving ventilation in indoor spaces, practicing good respiratory hygiene, and promoting early diagnosis and treatment are essential in preventing the spread of tuberculosis.

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Several strategies

Considering the global burden of tuberculosis, several strategies are needed, and these include improved case finding and diagnostic capabilities. There is still a struggle to diagnose these cases early as some diagnostic tests can take up to 6 weeks to give us a result.

Dr Mzimela emphasises the importance of health education and reducing the spread in vulnerable communities, improving access to first line and second line drugs, and ensuring adherence to treatment regimens. “By raising awareness, promoting early detection, and ensuring access to quality healthcare, we can work towards a future free of tuberculosis-related suffering and mortality” she says.

Also read: How is HIV transmitted?

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