(Image: TB HIV Care’s mobile x-ray unit)

Tuberculosis: Frequently asked questions

Tuberculosis (TB) is still one of the most stigmatised, feared and misunderstood diseases in the world. Many people don’t know the facts, recognise the symptoms or know when to be screened for TB.

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It is an air-borne disease (spread from person to person through coughing and sneezing) and while it most commonly affects the lungs (pulmonary TB), it can actually spread to other parts of the body too, including the brain (meningeal TB), kidneys, spine, urinary tract, bones and sexual organs.

Here we address the most frequently asked questions, so you know the facts and can help prevent the spread of TB.

1. What are the symptoms of TB?

 The most common symptoms of TB are:

• An ongoing cough (of 3 weeks or more)
• Fever
• Night sweats
• Unexplained weight loss

Other symptoms may include chest pain, pain on coughing and coughing up blood. It is always important to visit your doctor if you have any of these symptoms, and ask them to rule out TB.

2. Who is most at risk of developing TB

 Anybody who is exposed to TB (and breathes in the TB bacterium) is at risk of developing TB. TB is often perceived as a disease of the poor. Although people who are malnourished and live in overcrowded settings are at greater risk, the reality is that anyone can get TB.

In fact, someone can be infected with TB and never become sick or infectious to others – this is what is known as latent TB. This happens in 90% of cases where people with normal immune systems are infected with TB. In a country such as South Africa where TB prevalence is high, it is believed that many of us already have latent TB infection. For those of us who have latent TB, if we have healthy immune systems, we are very unlikely to ever even know that we have the infection or become sick.

TB is an ‘opportunistic disease’ this means it targets people who already have a weakened immune system, including:

• People living with HIV
• Patients who have other chronic conditions (like diabetes) or who are on dialysis
• The very young or the very old

3. Are there different kinds of TB?

 There are essentially three different kinds of active TB:

• The most common form of TB responds to medication and is usually cured after six months of treatment
• Multidrug-resistant tuberculosis (MDR-TB). MDR-TB is less common and is resistant to standard TB medication. It requires specialised, expensive medication and can take over 18 months to treat
• Extensively drug-resistant tuberculosis (XDR-TB) is rare, and occurs when a person is resistant to most medications and requires highly specialised care.
  

4. How is TB spread?

TB is spread through the air from one person to another. This happens when someone with TB coughs, sneezes – or even sings. If someone nearby breathes in the TB bacteria they can also become infected with TB.

5. What is the difference between latent TB and active TB?

Latent TB is a condition in which TB bacteria survive in the body in a completely dormant state. A person with a strong immune system may have latent TB – but never actually develop the disease. People with latent TB do not feel sick, do not have any symptoms, are not contagious and cannot spread the infection to others.

6. What is the treatment for TB?

Patients with active TB require a long course (6 months) of treatment involving multiple antibiotics. In order for the patient to be cured, they have to adhere to their treatment and complete the course in full.

A person on effective treatment is no longer infectious after about 2 weeks – so TB treatment is crucial to stop the spread of the disease.

7. What are the side effects of TB treatment?

The side effects of TB treatment will differ radically from person to person. Some people might feel mild symptoms while others might experience quite severe symptoms (and then the doctor will look at adjusting the treatment). But common side effects may include:

• Feeling sick or dizzy
• Skin rashes
• Pins and needles
• Flu like symptoms
• In very few cases people may experience jaundice, which is the yellowing of skin or eyes. If this happens, you need to stop taking your medication and tell your doctor straight away

A patient’s side effects need to be managed in the best way possible, so they are able to adhere to their treatment and complete the course in full.

8. Should people on TB treatment follow a special diet?

The best defence against TB is a strong immune system. The TB bacteria results in changes in the body that could affect one’s nutritional status, such as increased energy expenditure, loss of appetite, fever, loss of protein stores, increased demand for vitamins and minerals and a decrease in trace minerals in one’s body. So, having TB means that you will have to increase your total energy and protein intake. You can do this by:

• Eating smaller meals more frequently to help you increase your total daily intake of food and energy if you don’t have much appetite
• Eating foods that you enjoy or that are appetising for you (something is better than nothing)
• Eating plenty of fruits and vegetables every day to ensure you get adequate amounts of vitamins and minerals. These help you to stay healthy and to support your immune function.
• Increasing your daily protein intake: Make use of dairy products, nuts, seeds, eggs and fish/meats in your diet.
• Eating at least 2-3 portions of dairy a day (milk, cheese, yoghurt) for adequate Calcium and vitamin D intake.
• Increasing the energy density of your foods by eating full cream products or by adding milk, milk powder, nuts, seeds, nut butters, avocado, seed oils and even sugar to your foods. (You may think these are unhealthy additions to your diet, but if it helps to prevent dangerous weight loss, it would be beneficial for this temporary period of treatment).

Speak to a dietician or healthcare provider to ensure you are boosting your health and immune system while on TB treatment.

9. Can TB come back after treatment?
   

Treatment is only stopped once the TB bacteria is completely eradicated and you are cured and have the all clear. Therefore, TB can’t ‘come back’ – but unfortunately it is possible to catch TB more than once, if you are unlucky enough to be exposed to TB for a second time.

10. What happens if you don’t treat TB?

TB bacteria usually attack the lungs (pulmonary tuberculosis), but it can affect any part of the body such as the kidneys, spine or brain. Unfortunately, if not treated properly, TB can be fatal.

11. How can you prevent TB?

 TB can be prevented in a number of ways:

• BCG vaccination
• Early diagnoses and treatment
  • Early diagnoses and treatment is still the most effective way to prevent the spread of TB (a person is no longer infectious after about 2 weeks of treatment)
• Managing your environment
  • Good ventilation/opening the windows: TB can remain suspended in the air for several hours with no ventilation.
  • Natural light: UV light kills off TB bacteria
  • Good cough hygiene: Covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria
• A healthy immune system
  • Having a healthy immune system is one of the best forms of defence against TB
• Not smoking

 

The most important message is to look after yourself, take control of your health and see your doctor as soon as possible if you have any concerns. As with any illness, the earlier treatment begins, the better the outcome.

Remember: TB can be treated and TB can be cured.

TB HIV Care is a non-profit company dedicated to preventing, finding and treating TB and HIV.