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TB demystified

Tuberculosis TB

TB has been identified as the leading cause of death in South Africa, according to TBFACTS.org. Here is everything you need to know about this lung-attacking disease. 

Tuberculosis (TB) is a chronic infectious disease caused by a bacterium called mycobacterium tuberculosis. This bacterium usually manifests and destroys parts of the lungs, making it difficult to breathe, but can also spread to and attack other parts of the body such as the bones, joints and nervous system.

According to the World Health Organization (WHO), South Africa has one of the world’s worst TB epidemics, with an estimated incidence of 500 000 cases of TB disease in 2011. To put this in perspective, about one percent of the population of about 50 million develop TB disease each year. This is worldwide the third highest incidence, and the incidence has increased by 400 % over the past 15 years.

Who gets TB?

TB can affect people of all ages, nationalities and socio-economic groups. However, there are risk factors that increase your likelihood of developing TB. These include:

  • Being HIV-positive. More than half of all TB patients also have HIV. The latest figure from the South African Department of Health is that 73 % of TB patients are HIV positive.
  • Being in close contact with someone who has TB.
  • Being born where TB is common.
  • Living in an area where overcrowding, poor ventilation, malnutrition, substance abuse, and unemployment are rife.
  • Having a condition that weakens the immune system such as diabetes, cancer or kidney disease.
  • Having already been infected with TB in the last two years.

Babies and children younger than four years old are especially at risk of developing TB more easily and may develop serious complications as a result.

How TB is spread

TB is transmitted through the air. When a person with TB of the lungs or throat coughs, sneezes, or talks, droplets of the TB bacteria are released into the air. People nearby may breathe in these bacteria and become infected.

TB bacteria can stay airborne for a few hours and remain active in the air for weeks, especially in small enclosed areas. Fresh air and sunlight make it more difficult for these bacteria to stay alive. Transmission, however, usually occurs after substantial exposure to someone with the disease. The closer you are to the person with the disease and the longer you are exposed to them, the higher your risk of being infected.

The concentration of infectious droplets in the air can also affect your chances of being infected. Effective TB treatment can significantly reduce the number of infectious droplets released by a person with TB disease. The strength of a person’s cough can also affect the number of droplets released.

People with TB disease are most probable to infecting those they spend time with daily. Getting TB from someone coughing in a public place is highly unlikely. TB is NOT spread through physical contact, e.g. kissing or shaking hands, toilets seats, bedding, clothing, or food and water.

Not everyone who is infected becomes sick

TB bacteria can live in the body for years without any symptoms or spreading to others. This is called latent TB. According to the South African National Tuberculosis Association (SANTA), about 80 % of South Africans are infected with TB bacteria – most of whom have latent TB, rather than TB disease. The highest prevalence of latent TB, estimated at 88 %, has been found among people ages 30-39 years old living in informal settlements.

People with latent TB have a small number of TB bacteria present in their body. It is usually only known that someone has the condition if they have a positive skin test reaction. Having latent TB does not mean you will develop TB disease. For most people with latent TB, the immune system is able to control the infection by forming walls around the bacteria, which prevents the bacteria from growing but does not kill them. However, these bacteria can become active and multiply in the body. When this happens, latent TB infection can develop into TB disease.

This usually occurs in those with a weak immune system due to infection or some other health condition. The risk of developing TB disease is much higher in people with weak immune systems (especially those with HIV infection) than those with normal immune systems. TB disease is infectious and can be spread easily to others.

The search for a cure

The search for better and more effective medicines to cure TB continues. The current medicines remain the most powerful for now. BCG (Bacillus Calmette-Guerin) is still the only vaccine and is only effective in children under five years old.

“Students at both Stellenbosch University and the University of The Western Cape are busy with TB research which is in various stages of advancement, but the solution is still far from being found,” says Derick Esterhuizen, Western Cape Provincial Manager of SANTA. “Aeras and SATVI (South African TB Vaccine Initiative) also continue with their research to find a new improved vaccine and medication.”

TB care

If TB becomes active it needs to be treated early before it causes too much damage. Signs and symptoms of TB to be aware of include:

  • Persistent cough lasting longer than two weeks
  • Fever
  • Night sweats
  • Chest pain
  • Weakness and fatigue
  • Poor appetite
  • Rapid weight loss

If you have one or more of these symptoms, visit your nearest clinic and get tested for TB immediately. Should you be diagnosed with TB, make sure you get the correct medical treatment and that you complete the full course of prescribed drugs. Successful treatment takes at least six months, and medication must be taken exactly as prescribed. Incomplete treatment or not following a consistent treatment regimen may cause you to develop drug-resistant strains of TB, which may be extremely difficult to cure and can even be fatal.

A balanced diet, regular exercise and vitamins, avoiding drugs and alcohol, and getting enough fresh air and sunlight are also important in managing and treating TB.

References

Tuberculosis (TB). [Online] Available at: http://www.health24.com/Medical/Tuberculosis/About-tuberculosis/Tuberculosis-TB-20120721. Accessed 1 March 2016.

Who gets TB? [Online] Available at: http://www.health24.com/Medical/Tuberculosis/Faqs/Who-gets-TB-20120721. Accessed 1 March 2016.

Basic TB facts. Centres for Disease control and Prevention. [Online] Available at: http://www.cdc.gov/tb/topic/basics/. Accessed 1 March 2016.

 TB in South Africa. South African National Tuberculosis Association. [Online] Available at: http://www.santa.org.za/tb-in-south-africa.html. Accessed 1 March 2016.

TB – What is TB, Tuberculosis, latent TB, TB disease. TB Facts [Online] Available at: http://www.tbfacts.org/tb/. Accessed 1 March 2016.

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