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Tuberculosis (TB): Can We Overcome It?

  • Writer: Polelo Mawela
    Polelo Mawela
  • Mar 26, 2023
  • 4 min read


Mycobacterium Tuberculosis (MTB) is the causative agent of tuberculosis (TB), an airborne infectious disease that mostly affects the lungs (Acharya et al., 2020). Most cases of tuberculosis are pulmonary (between 80%). Extra-pulmonary tuberculosis (EPTB), which can affect the colon, meninges, lymph nodes, bones, joints, kidneys, spine and skin, is also a possibility (Acharya et al., 2020). Tuberculosis (TB) is an endemic disease to Africa with an incidence rate of (25%) incident cases worldwide in 2021 (Ayles, Mureithi, & Simwinga, 2022).


TB remains a public health issue of concern, especially in countries with low socio-economic status and high rates of Human Immunodeficiency Virus (HIV) infection (Schito, 2015). TB is the most prevalent opportunistic illness in patients with HIV, its prevalence is directly correlated with that of HIV (Van Dyk, Tlou, E, & Van Dyk, 2017). In comparison to the global incidence of 1.2%, sub-Saharan Africa has the highest prevalence of HIV at 9% (Ayles, Mureithi, & Simwinga, 2022). Co-infection with these two viruses accelerates the course of the two diseases and creates difficult diagnostic and therapeutic hurdles Van Dyk, Tlou, E, & Van Dyk, 2017).

South Africa is one of the 30 high TB burden countries, it accounted for 3.3% incident cases worldwide in 2021 (Ayles, Mureithi, & Simwinga, 2022). In South Africa, the TB care cascade shows that just 53% of potential cases end up being successfully treated: 5% are lost at test access, 13% at diagnosis, 12% at treatment initiation and 17% at successful treatment completion (Daniels et al.,2019 p.1). Given that patients infected with TB can recover fully, the WHO aims to end the global TB epidemic by reducing TB deaths by 95% and to cut new cases by 90% between 2015 and 2035 (WHO, 2017) . The WHO aims to achieve this by upholding 3 pillars;


· Integrated TB care and prevention that is patient-centred

· Supportive systems and policies that are bold

· Intensified research and innovation.


These pillars are underpinned by four key principles:

· Government stewardship and accountability, with monitoring and evaluation.

· Strong coalition with civil society organizations and communities.

· Protection and promotion of human rights, ethics and equity.

· Adaptation of the strategy and targets at country level, with global collaboration (WHO, 2017).


As such the reduction of TB is layered and calls for collaborations amongst various levels and expertise in society. Factors that facilitate the spread of TB in South Africa include; inadequate health-care system response, poverty and global inequity (Singh, Upshur, & Padayatchi, 2007). According to South Africa's Medical Research Council, about half of adults in South Africa with active TB are cured each year, compared with 80% in countries with better resources. A neglected but significant factor fuelling the TB outbreaks in South Africa is the lack of infection control in institutions, including the lack of simple administrative measures such as triaging of patients, as well as more sophisticated expensive environmental control measures, such as negative pressure rooms and personal respiratory protection (respirators). Infection control must be addressed in order to reduce the nosocomial transmission of these infections (Singh, Upshur, & Padayatchi, 2007).

The solution to reducing TB seem to be clear and well-articulated by various institutions and experts however the burden remains and in recent times the COVID-19 pandemic has also exacerbated all pulmonary infections including TB (Visca, et al., 2021). Based on the immunological mechanism involved, a shared dysregulation of immune responses in COVID-19 and TB has been found, suggesting a dual risk posed by co-infection worsening COVID-19 severity and favouring TB disease progression (Visca, et al., 2021 p. 152). Given the many facets to TB in terms of how big of a burden it is, can we overcome it?


Learn more and enjoy CPD courses: www.clinlib.com


Writer: Hlengiwe Selowa


Reference

  1. Acharya, B., Acharya, A., Gautam, S., Ghimire, S. P., Mishra, G., Parajuli, N., & Sapkota, B. (2020). Advances in diagnosis of Tuberculosis: an update into molecular diagnosis of Mycobacterium tuberculosis. Molecular biology reports, 47, 4065-4075.

  2. Ayles, H., Mureithi, L., & Simwinga, M. (2022). The state of tuberculosis in South Africa: what does the first national tuberculosis prevalence survey teach us?. The Lancet Infectious Diseases, 22(8), 1094-1096.

  3. Daniels, B., Kwan, A., Pai, M., & Das, J. (2019). Lessons on the quality of tuberculosis diagnosis from standardized patients in China, India, Kenya, and South Africa. Journal of clinical tuberculosis and other mycobacterial diseases, 16, 100109.

  4. Schito, M., Migliori, G. B., Fletcher, H. A., McNerney, R., Centis, R., D'Ambrosio, L., & Zumla, A. (2015). Perspectives on advances in tuberculosis diagnostics, drugs, and vaccines. Clinical infectious diseases, 61(suppl_3), S102-S118.

  5. Singh, J. A., Upshur, R., & Padayatchi, N. (2007). XDR-TB in South Africa: no time for denial or complacency. PLoS medicine, 4(1), e50.

  6. Van Dyk, A., Tlou, E. R., & Van Dyk, P. (2017). HIV and AIDS: Education, Care and Counselling, a Multicultural Approach. Pearson.

  7. Visca, D., Ong, C. W. M., Tiberi, S., Centis, R., D’ambrosio, L., Chen, B., ... & Goletti, D. (2021). Tuberculosis and COVID-19 interaction: a review of biological, clinical and public health effects. Pulmonology, 27(2), 151-165.

  8. World Health Organization. (2017). Ethics guidance for the implementation of the End TB strategy (No. WHO/HTM/TB/2017.07). World Health Organization.

 
 
 

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