TB – Hello Doctor

Why you owe it to yourself to get a TB test

February 27th, 2023 by The Hello Doctor Team

The single largest infectious killer of humans for centuries is a curable disease – and we have the potential to put an end to unnecessary deaths. It all starts with knowledge.

Do you know what the leading cause of death in South Africa is? It may surprise you to learn that it is a treatable disease. Tuberculosis, commonly called TB, takes far too many lives every year. What’s worse, numbers are still climbing. For a condition that can be successfully cured, this is unacceptable.

So how can we beat TB? The answer lies in getting diagnosed and treated – for that to happen, we need to fight the stigma. TB Awareness Month aims to do just that.

Stop the stigma to win the war

Because TB often occurs along with HIV/AIDS, sufferers can be reluctant to share their diagnosis. There’s also the stigma of contributing factors like overcrowding, malnutrition, and alcohol and drug abuse. Yes, these do play a role, but anyone, anywhere, from all walks of life can get TB. In fact, an estimated 80% of people in SA have been infected with the bacterium that causes TB. There can be no shame when the majority of people you know already carry TB.

But it’s human nature to want to hide from bad news – we just can’t face what diagnosis might mean so we avoid finding out. People are also afraid of the stories about TB medication side effects. But the reality is that TB will not go away by simply pretending that it doesn’t exist – this only makes things worse.

The good news is that TB can be treated by following the prescribed course of treatment. The bad news is that we cannot treat what we don’t know is there, which is why putting aside fears and stigmas to get tested is crucial… the sooner, the better.

Steps to tackle TB

Know your status
The World Health Organisation estimates that 40% of people infected with TB don’t get diagnosed. Without diagnosis, they’ll never get the help they need. TB tests are quick and, in SA, they’re free at government clinics. Two sputum (spit) samples are taken and results are available within a few days.
Look after yourself
Give yourself a fighting chance of beating any bugs and, if you do get sick, of recovering more quickly. A balanced diet with fruits, vegetables, protein and wholegrains is crucial. Daily exercise, particularly in the fresh air, helps to keep your body healthy and combats stress, which also affects the immune system. And, of course, steer clear of smoking and alcohol.
Vaccinate your children
The BCG vaccine against TB is crucial for children as they’re at a higher risk, both of contracting TB and of developing severe forms, such as deadly TB meningitis or TB affecting organs besides the lungs. The vaccine is generally not given to adults as it’s less effective than when given to children.
Be considerate
Remember the lessons we learnt from COVID-19? When coughing or sneezing, cover your mouth and nose with your arm or a tissue, don’t spit and keep your distance from others. If you’ve been diagnosed, be courageous by telling those you’ve interacted with so they can be tested too.
Complete your treatment
If you’re diagnosed with TB, you’ll be prescribed a course of medication that lasts at least six months. It is true that the treatment can have side effects but, fortunately, new breakthroughs are set to improve this. What’s more, after just two weeks on treatment, most people are already no longer infectious, so you can stop the spread. Because it takes longer to completely rid yourself of TB, it’s vital to complete the full treatment. Sticking to your treatment programme is truly the most powerful thing you can do to help yourself and everyone around you.

TB has been with us for thousands of years. But, today, with unprecedented access to information, new treatment programmes and fast, painless testing, we’re in the best position ever to overcome it. By working together, we can end TB – once and for all.

Where to find help online

For information and education about TB: TB Proof
For advice, information and resources on TB and HIV: TB/HIV Care Association
Join the Tuberculosis Support Group – South Africa on Facebook or ask your local clinic for support group referrals.

References

TB awareness – the role of chronic stress and mental health in disease risk

March 8th, 2022 by The Hello Doctor Team

We are living through some pretty stressful times. The COVID-19 pandemic has brought with it unprecedented levels of social, economic and mental stress, and no-one has been spared. Even if someone hasn’t been directly affected by the virus itself, there has been some level of disruption to their employment, living arrangements, family dynamics or income. After nearly 2 years of living with these disruptions, change and uncertainty, day in and day out, the stress that is associated with them has become ‘normal’. The truth is; this type of ‘new normal’ is anything but. Even though you may not feel the same heart-pounding, sweat- inducing worry that you once did, chronic, unabated stress can start to take a toll on your health – both physically and emotionally.

Even for those who are healthy, the pandemic has highlighted the idea of a disease being front and centre in all you do in your life. However, for someone who might have living with a chronic disease long before COVID-19 came along, this has already been their reality, and the pandemic has simply made things worse.

Economic, social and psychological distress is common amongst those living with chronic diseases, such as tuberculosis. This type of distress is similar to COVID-related change. Someone affected by TB may not be able to work. Particularly those who aren’t able to work from home may find themselves unemployed. They may have to isolate at home, they may be shunned by their community, and may be unable to access the treatment necessary to manage their condition. Unsurprisingly, besides tuberculosis being one of the leading causes of death in South Africa, it is also one of the biggest drivers of mental distress.

Several studies have found a strong link between tuberculosis and psychological distress, showing that up to 80% of patients with TB experience mental health problems. But something less often reported is that this relationship can be bi-directional. In other words, general mental distress, emotional turmoil, and social isolation, may be considered an important risk factor for the development of TB.

Poor mental health and chronic stress deliver a devastating blow to the immune system. These conditions, via changes in the release and regulation of hormones, impair the healthy functioning of the immune system, thus resulting in an increased risk of infections, chronic metabolic disease (e.g. diabetes), and sometimes even cancer. In the case of TB, a lowered immune status could also mean an increased risk of activation of a latent TB infection to an active one.

There has been much progress in the fight against TB, specifically with recent advances in the development of new vaccines and medications. While these developments are encouraging, it’s important to take a holistic look at TB prevention and consider the important role that stress and mental health have in both the development of the disease, and the management of it.

Here are 8 ways that you can contribute to lowering the TB burden in your community, and improve your own resilience to infection:

Become aware of your current stress levels and take a proactive approach to managing these. Regular exercise, meditation, engaging with others and spending time in nature can all be effective in easing stress levels.
Speak out when feeling overwhelmed, and if you experience mental health concerns, ensure that you seek treatment.
Maintain strong social ties to help buffer the negative effects of stress.
Live a healthy lifestyle – by eating well, exercising regularly and prioritising sleep, you give your immune system the best chance of keeping you healthy.
Act early – the sooner you can be diagnosed and treated; the more successful treatment will be.
Manage existing conditions – keep chronic conditions, like HIV and diabetes, under control and take medication for these conditions as prescribed.
Ensure your children are vaccinated against TB.
If you have active TB, ensure you continue to take your medication for the full duration – not only for your own sake, but for everyone else around you too.

References

Can HIV increase your risk for TB?

January 23rd, 2019 by The Hello Doctor Team

Tuberculosis (TB) is the world’s leading infectious killer. It’s also the number one cause of death among HIV-positive people. In 2015, over 10 million people across the globe had TB disease. Of these, about one million also lived with HIV (Human Immunodeficiency Virus).

If you’re wondering why these two infections often go together, and what you can do to stay free of TB if you’re HIV-positive, read on.

Why HIV increases your risk for TB

HIV is a virus that destroys those cells in your body that help to fight germs and infections. These are called CD4 cells. When you don’t manage your HIV properly, your body finds it hard to fight off the bacteria that cause TB.

If you’re healthy, your immune system is usually able to destroy TB bacteria before they make you sick. But if your immune system is struggling because of HIV, the TB bacteria can infect your body and stay there. The bacteria can either make you sick straight away or cause symptoms (e.g. coughing, chest pain, or coughing up blood) at a later stage.

Your risk of getting TB increases about three weeks after first becoming infected with HIV. If your HIV is not managed with antiretroviral treatment (ART) this risk can double by the end of your first year of HIV infection. If you’re HIV-positive, your risk of getting TB is around 27 times higher than people who don’t have HIV.

How TB hurts if you have HIV

If you do get TB, it can affect how fast HIV develops into AIDS (the final stages of HIV infection when your immune system is very weak). The TB infection speeds up the loss of your infection-fighting CD4 cells and ups your risk for other life-threatening infections.

While your body is focussed on fighting the TB bacteria, it takes the pressure off the HI virus, which means it can make new copies of itself faster.

How TB spreads

When you come into close contact with someone who has TB, you can easily become infected. When someone who is infected with TB coughs or speaks, the bacteria spreads through the air. If you’re nearby, you may breathe in the bacteria and become infected, too. The bacteria can lodge themselves in your lungs and begin to replicate. From here, they can move through your blood to other parts of your body, including your kidneys, bones and brain. When this happens, your life could be at risk.

Tips to prevent TB disease

If you have HIV, it’s important to take great care to prevent TB disease.

Start ART as soon as possible. Visit a doctor or clinic without delay, as your risk for TB and other infections is high.
Take your antiretroviral treatment as prescribed, for the rest of your life. This will help keep your immune system strong.
Get tested for TB. This is easily done with a blood or sputum test at your doctor’s consultation rooms or clinic.
Speak to your doctor about using an anti-TB drug. If it is prescribed, it’s important to complete the course.

If you do get TB, complete your course of antibiotics and regularly check in with your doctor to see if the medicine is working. If you don’t use your medicine exactly as prescribed, the TB bacteria may become stronger, and therefore harder to kill.

References:

Pneumonia – what you need to know

October 27th, 2017 by The Hello Doctor Team

Pneumonia is a lot more common than most people realise. It’s a serious illness, which can be life-threatening if the correct treatment isn’t given timeously.

What is pneumonia?

pneumonia is an infection of either one, or both, lungs
when a person has pneumonia, the alveoli of the lungs become inflamed
alveoli are tiny air sacs within the lungs, that allow for the movement of oxygen and carbon dioxide between the lungs and the bloodstream

What are the causes for pneumonia?

Bacteria: the most common causes are: Streptococcus pneumonia, Haemophilus influensae, Moraxella catarrhalis, TB
Viruses: the most common causes are: influenza A and B, swine flu, RSV, SARS virus, rhinovirus, measles virus, varicella-zoster (chicken pox) virus, herpes simplex virus
Fungi: more common in people with weakened immune systems and people who have chronic illnesses
Bacteria-like organisms: for example, Mycoplasma pneumoniae (the so-called “atypical pneumonia”)
Chemical or aspiration pneumonia: when either chemicals, food, drink, vomit or saliva enters the lungs. This is more commonly seen in patients who have an impaired gag reflex

Does it make a difference how, or where, one gets pneumonia?

Community-acquired pneumonia

this refers to pneumonia that people get outside of a hospital, or a health care facility (such as nursing home, rehabilitation or frail care centre)
it is usually easier to treat

Hospital-acquired pneumonia

this refers to pneumonia that a patient gets whilst being in hospital
you can also get this type of pneumonia in an ICU or in association to being on a ventilator
this type of pneumonia can be more resistant to anti-biotics

Who is at risk of getting pneumonia?

children under the age of 2 years, and adults older than 65 years of age
smokers
people who are immune-suppressed (HIV+, cancer patients, patients taking long-term steroids)
people with chronic diseases (diabetes, heart disease, asthma, COPD, cirrhosis, cystic fibrosis, bronchiectasis)
being hospitalised, recent surgery or trauma
having had a recent viral respiratory infection (increase the risk of a secondary bacterial infection)
neurological impairment (Parkinson’s disease, stroke, dementia, motor-neuron disease, M.S.)
living in a nursing home or frail-care facility, or a hostel

How is pneumonia treated?

Treatment of pneumonia depends on various factors:

the age of the patient
the type of pneumonia (community vs. hospital-acquired)
the underlying cause of the pneumonia
how seriously ill the patient is clinically
whether the patient has other chronic illnesses, or is immune-suppressed

Treatment can include:

Rest and adequate fluid intake
Anti-biotics or anti-viral medication, if needed
Medication to lower a fever/temperature (paracetamol, anti-inflammatories)
Cough medication (a cough suppressant should only be given if a doctor specifically prescribes one)
Hospitalisation (if a patient is seriously ill, intravenous fluids and anti-biotics may be necessary, oxygen, nebulisation, chest physiotherapy, special breathing exercises, or ICU admission for possible ventilation)

Can pneumonia be prevented, and if so, how?

Not all cases of pneumonia can be prevented, but there are things one can do to lower the risk of acquiring this potentially serious illness:

Covering one’s mouth and nose when coughing and sneezing prevents the spread of pneumonia
By observing good hand hygiene and washing one’s hands regularly and thoroughly
By not smoking
By staying away from people who are already ill with respiratory tract infections
People who are already ill with pneumonia or a respiratory tract infection should stay off work or school to recover and prevent spreading the infection to others (via coughing and sneezing )
By being vaccinated (annual flu virus vaccine, pneumococcal vaccine for age 65+ and patients with chronic illnesses, Measles and Chicken pox vaccine in certain cases)
By eating a healthy diet and maintaining a healthy body weight
HIV+ patients should discuss additional ways that they can prevent certain types of pneumonia and other infections, with their doctor

If you’re worried about any chesty symptoms, chat to one of our doctors. They’d be happy to help, and are available 24/7, 365 days a year.

Fever & coughing: is it just flu or could it be TB?

August 11th, 2017 by The Hello Doctor Team

Earlier this year, there was an outbreak of drug-resistant Tuberculosis in Australia. It started when a doctor in Sydney misdiagnosed a student with asthma and lung cancer – before realising it was TB.

Scary stuff! It’s understandable, though: TB shares symptoms with other conditions, such as flu, but they should be treated with completely different medications.

TB is caused by the organism Mycobacterium tuberculosis, which is easily spread when people with active lung disease expel the small airborne TB particles from their lungs into the air through coughing. Other people then breathe in the infectious droplets into their lungs, where the bacteria begin to multiply.

Influenza (flu) is caused by an influenza virus. The virus “sits” in the infected person’s nose and throat and when they speak, sneeze or cough, the virus becomes active – and infectious. It can be left on hands, surfaces, and items like tissues, washcloths and handkerchiefs. You can be infected with flu viruses via the air, or an infected hand or object touching your nose or mouth.

Symptoms in common

General coughing
Chest pain
Difficulty breathing (shortness of breath)
Weakness and fatigue
Loss of appetite and weight
Chills and fevers
Joint pain
Diarrhoea

TB is a beast of a disease that’s wreaking havoc across the country and continent. According to the World Health Organization, South Africa has the third highest incidence of any country after India and China.

How to know the difference:

A cough that starts out dry but later produces sputum (thick liquid from deep inside the lungs) or blood.
Coughing for longer than a month.
Rales (strange, rattling sound in the lungs when breathing).
Excessive sweating, including sweating at night.
Hearing loss.
Diarrhoea.
A persistent lump or lesion. (Especially lumps under the arms, from the lymph glands).
Clubbing of fingers or toes; (the nails become swollen, making the fingers look a bit like drum-sticks).

Those at risk for TB:

A weakened immune system is the most important factor in the development of TB after exposure to the organism. Even though research hasn’t directly linked TB to stress, it’s suggested that excessive stress weakens the immune system and generally increases one’s risk of contracting diseases. 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. You are at higher risk of getting TB, if you:

have been in close contact with someone who has TB.
were born where TB is common.
live in an area where overcrowding, poor ventilation, malnutrition, substance abuse, and unemployment are rife.
have a condition that weakens the immune system (diabetes, cancer or kidney disease).
have already been infected with TB in the last two years.

When do I need the doctor?

In both conditions, you need medical care:

To prevent flu, you’ll need the flu-vaccine, and you can treat the symptoms with over-the-counter medication from your chemist.
For TB, you will take a TB test. Your doctor will then prescribe TB medication: which you will need to stay on until the course is complete: 6 months.

If any of the risk-factors apply to you, and you get a cough, it’s best to see your doctor ASAP. To treat TB successfully 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.

References

The cost of tuberculosis

April 18th, 2017 by The Hello Doctor Team

Tuberculosis (TB) is a chronic infectious disease caused by a bacterium. It destroys parts of the lungs, making it difficult to breathe, but can also spread to and attack the bones, joints and nervous system.

The World Health Organization (WHO) estimates that about one percent of our population develops TB disease each year.

In South Africa the resistant strains of TB are on the increase. In fact, only five percent of TB is drug-resistant worldwide. This means that they are difficult to treat, time-consuming, and expensive.

According to WHO, it can cost several hundred times more to treat drug-resistant TB than TB that responds to standard drugs. A recent study found that drug-resistant TB can cost South Africa over R200 000 to treat (per patient).

Why so expensive?
There are two main types of drug-resistant TB: multi drug-resistant tuberculosis (MDR TB) and extensively drug-resistant TB (XDR TB). Multidrug-resistant TB (MDR TB) occurs when the bacteria become resistant to at least the two first-line drugs, Isoniazid and Rifampin.

This type of TB may emerge if:

You don’t take your medication regularly.
You don’t complete the full six month schedule.
You spend time with someone who has MDR TB. Crowded places and poor ventilation can increase your risk.
The wrong drugs or combination of drugs are prescribed.
The drug supply is unreliable or of poor quality.

XDR TB is a sub-form of MDR TB with additional resistance to anti-TB medications, meaning it responds to even fewer drugs.

Both MDR-TB and XDR-TB don’t respond to the standard six months of TB treatment with first-line anti-TB drugs. Treatments options are more expensive, not always available and aren’t guaranteed to work. Less than half of those infected are ever cured.

What’s more, these drugs can be costly to your health. You may have severe side-effects like deafness and psychosis. In some cases, even more severe drug resistant strains could develop. With new MDR TB strains on the rise and additional resistance to other drugs available for treating tuberculosis, the worst case scenario is that TB will become completely untreatable.

What you can do

Take your TB medication exactly as prescribed by your doctor.
Don’t stop your treatment early, even if you feel better.
Avoid those infected with TB or MDR TB.

Reference:

How to live better with TB

March 23rd, 2017 by The Hello Doctor Team

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

TB bacteria can live in the body for years without any symptoms or spreading to others.

How TB is spread
TB travels 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.

Signs and symptoms of TB include

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

Treatment
Successful treatment takes at least six months, and medication must be taken exactly as prescribed. Incomplete treatment or not following a consistent program may cause you to develop drug-resistant strains of TB, which could be extremely difficult to cure, and even fatal.

Patients are put on a course of treatment for six to eight months as soon as TB is diagnosed. You will then receive tablets, and in some cases, injections for the first two months of treatment.

The treatment is also known as DOTS (Daily Observed Treatment Short course). The tablets have to be taken under supervision to guarantee regular and effective therapy.

Patients usually respond well to treatment and can soon return to work and live relatively normally again.

Good to know

Stay on track with all your medical appointments.
Take your medicines as prescribed.
Report any side-effects of your medication. If you plan to move during the time that you’re being treated, let your doctor know so that arrangements can be made for you to continue the treatment.
Healthy eating and exercise will keep your immune system strong and help to prevent TB, and help you to recover faster.
During treatment, eat healthy foods and get enough sleep.
Aim for at least 30 minutes of exercise a day to help your body fight off the infection.

Keep safe

Don’t spend long periods in stuffy, enclosed rooms with anyone who has active TB until that person has been treated for at least two weeks.
Use protective measures, like face masks, if you work in a facility that cares for people who have untreated TB.
If you live with someone who has active TB, help and encourage the person to follow treatment instructions.
Cover your mouth when you sneeze or cough so as not to infect your family. Oranges, bananas and garlic are helpful in easing symptoms as they inhibit bacterial growth and boost your immune system.

References:

http://www.webmd.com/lung/tc/tuberculosis-tb-home-treatment

Can we stop TB for good?

March 1st, 2016 by The Hello Doctor Team

Tuberculosis is a deadly disease that takes away 1.5 million lives from us every year. 1.5 million is not just a number – it also represents a sister, a child, a mother or a friend that could have been saved. TB is preventable and curable, and it’s up us to fight it.

The 24th of March is World TB Awareness day: so let’s gear up our knowledge so we can win this war. Continue reading “Can we stop TB for good?”

Coughing: How do you know if you have TB?

August 25th, 2015 by The Hello Doctor Team

So, you’ve been coughing for a few months now and sweating at night… even your friends are saying you’ve lost some weight and should go for a TB test. TB is very common in South Africa, but fortunately it can be prevented and treated. Here’s what you need to know.

Preventing TB:

a) By the BCG (TB) vaccine:

In countries where TB is common, the BCG forms part of the national childhood immunisation programme
It’s generally used to offer children protection against TB
It’s not used to interrupt the spread of TB from one adult to another

b) By preventing the spread of infectious TB from one adult to another. This is done by:

Identifying people with active TB early on, and
Treating them promptly with medication

TB is spread by airborne droplets, especially in crowded spaces. Here’s what you can do to prevent the spread of TB:

Ventilate the house/room properly
Cough, sneeze or laugh into a tissue and throw it away in a sealed plastic bag
Wash your hands after coughing or sneezing
Sleep alone in your own room
Do not attend school or work until a healthcare worker has declared it safe to do so
Avoid close household contact with children under 5 years old
Take all TB medication correctly for the correct length of time
Go for regular follow-ups and tests, to check if the TB medication is working and to see if it’s still infectious
Avoid crowded places

Tests for TB:

Deciding if a person has TB or not, depends on many things:

Symptoms suggestive of TB
A clinical suspicion of TB in a patient (by a trained healthcare worker)
TB screening tests such as:

Microscopy (examination of stained sputum smears under a microscope)
Culture (sputum culture of the TB organism; a process which takes longer)
PCR-based tests/molecular testing
Other tests including: chest X-ray, tuberculin skin test, blood culture, ultrasound, histological examination of tissue, amongst others

Treating TB:

The most important aspect of treatment is to take the correct medication for the correct length of time.

TB drugs – the essential TB drugs are given in different combinations according to different treatment regimens
Some TB drugs are bacteriocidal (killing action), bacteriostatic (sterilising action) or have the ability to prevent resistance
The most common drugs are: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin
Other TB drugs are used in specific circumstances
Some additional drugs include steroids and Vit B6

Common side effects of TB drugs include:

Joint pains
Nausea, loss of appetite, abdominal cramps
Burning, numbness or tingling of feet (and hands)
Orange/red discolouration of urine
Skin rash or itching

If you’d like more information about TB or TB medication, please chat to our doctors on the Hello Doctor app.

Join us in the fight against TB!

March 24th, 2015 by The Hello Doctor Team

Today is World TB Day – the focus is on a disease SA fights on a daily basis. Universities and organisations across South Africa and the world are in a constant battle to curb the spread of the TB. Continue reading “Join us in the fight against TB!”

High-carb meals may reduce the effectiveness of your TB meds

September 12th, 2014 by The Hello Doctor Team

It’s hard enough to accept that one has TB, but did you know that when you decide to eat can affect the efficacy of your treatment? A new study suggests that if you eat just before taking your TB medication, it can cut down on your medicine’s effects, especially if you’re in the early stages of treatment – it’s a tough pill to swallow. Continue reading “High-carb meals may reduce the effectiveness of your TB meds”