GF Jooste Hospital is a secondary level district hospital in the Cape Metro. The following is an extract from their PEPFAR supported TB education programme.
1. What is TB?
An organism called Mycobacterium tuberculosis, it is a very common infection in South Africa, especially in the Western Cape.
2. How does a person get infected with TB?
Usually by breathing in droplets of sputum if a person infected with TB is coughing. It spreads though the air and its easy to infect people around you when you are coughing around them.
3. What are the symptoms of TB?
This can vary, but the symptoms are usually coughing, sweating a lot at night, tiredness, poor appetite and loss of weight.
4. How is TB diagnosed?
Usually on a sputum test, but also on X ray or other scans such as ultrasound and sometimes by tapping water off the lung. TB infection can take a long time to prove and may require multiple tests.
5. What is the treatment for TB?
We treat TB with four different medications for 2 months (Combination tablet – four in one) and then with 2 medicines for another 4 months (Combination tablet – two in one). If you have TB for the second time the treatment is a bit more complicated with an injection for the first 2 months and the treatment is for 8 months in total.
6. Why does TB have to be treated for such a long time?
TB goes into cells in the body called macrophages and can survive inside those cells for a long time. If you do not complete the TB treatment the TB will just come out of these cells and start the infection again. It can also get to know the TB medication and become resistant to it, which makes it much more difficult to treat in the future.
7. What are the side-effects of TB treatment?
B medicines are strong and have several side effects. It ranges from vomiting, to skin rash, painful feet and liver problems. Each of these problems are managed individually and the TB sister or doctor will explain that if it should occur.
8. What is the risk to other people?
If you have untreated TB you can infect those around you by coughing around them. Adults with TB can especially give children TB as well. That is why it is important for the whole family to go for TB tests if someone in the house is diagnosed with TB.
9. How to prevent the spread of TB?
10. What to do about children in the household?
If an adult in the household is diagnosed with TB all children should go to the TB clinic for a TB screen. Children of certain age groups need to take TB treatment for some time even if they don’t have TB themselves. This prevents them from getting TB.
11. If someone else in your household develops symptoms they should go to the TB clinic.
12. What is the cure rate of TB?
If TB medication is taken correctly TB is curable. Gaps in treatment decreases the chances of successful treatment and increases the chances of getting resistant or stronger TB.
13. Can people die from TB?
YES. Many people still die from TB, especially if they wait long before going to test for TB or didn't complete TB treatment in the past.
TB and HIV
1. What is HIV and how does it affect the body?
HIV is a virus infection that makes the body's immune system weak and makes it less able to fight infections well. This means its easier to get infections like TB and also harder to treat these infections because your body is too weak to help fight the infection
2. If you have TB, why is an HIV test important?
Many people who have TB are also infected with HIV. It is very important to know your HIV status. It is much better to start HIV treatment early if your CD 4 count is low. This increases your chances of getting better from TB and do well on HIV treatment.
3. How does HIV influence the symptoms of TB?
In people with HIV the symptoms of TB is often more subtle. It can present with just loss of weight and poor appetite or just with tiredness.
4. How does HIV influence the diagnosis of TB?
TB is often more difficult to find in someone who is HIV positive. Sputum tests often need to be repeated and cultured which takes longer and the X ray does not always show TB and we need to do other tests like urine tests and blood tests and ultrasounds to help make the diagnosis.
5. How does HIV influence the treatment of TB?
Antiretroviral(ART) treatment and TB treatment share certain side-effects and sometimes the ART needs to be adjusted or changed or sometimes needs close monitoring with regular blood tests.
6. What is the cure rate in someone with TB and HIV?
The cure rate is supposed to be the same, BUT a person with advanced HIV has a higher chance of dying from TB or other infections than someone who is HIV negative.
7. How many HIV positive people die from TB?
Many HIV positive people die from TB, especially those people who have low CD 4 counts and are not taking ART yet.
1. What is MDR TB?
This is when TB is resistant against (too strong for) the 2 main TB medicines, called Rifampicin and Isoniazide. MDR TB needs to be treated with 5 other medicines and also be treated for much longer. Mostly for 18 months. This is much harder to cure than normal TB. Patients with MDR TB are usually isolated for the first 4 months of treament.
2. What is XDR TB?
This is when TB is resistant against (too strong for) the 2 main TB medicines, called Rifampicin and Isoniazide and to one more group of medicines. This is a very dangerous form of TB and even harder to treat than MDR TB. Patients with XDR TB are usually isolated for the duration of their treatment.
For more information on GF Jooste Hospital or their TB programmes: