Multi-drug resistant tuberculosis

Posted on 14 August 2013

Dr Dalene von Delft, involved in TB prevention plans at Mediclinic, contracted the multi-drug resistant form of TB (MDR-TB). Now healed, she heads up a TB treatment advocacy group, TB Proof. Here, she answers some questions about TB.

What, for you, is the greatest persistent misconception about tuberculosis?
The belief that only poor and immune-compromised people can get it. I saw many fellow classmates fall ill with TB over the years. We were all healthy, from good socio-economic backgrounds, with no immune compromise and no co-morbid illnesses. Since it’s an airborne infectious disease, anyone can get it.

You had a dry cough but few other symptoms. Should TB screening be considered in the average person’s health check-ups?
According to the International Standards of TB Care (ISTC), screening for TB is recommended in all patients that have an otherwise unexplained cough for more than two weeks. Other symptoms are loss of weight, loss of appetite, night sweats and tiredness.
But screening for TB is costly and without available treatment for latent TB (people who are infected don’t have the active disease), the value of screening is doubtful. In terms of screening, the highest-priority contacts for evaluation are: people with symptoms that suggest tuberculosis; children aged 5 and below; those with known or suspected immune-compromised states, like HIV; and people who’ve been in contact with patients with MDR or extensively drug-resistant TB (XDR-TB).

How serious is the threat from the drug-resistant ‘superbug’ forms of TB?
Very serious indeed. The cure rates for XDR-TB are less than most cancers. The only difference – this is like ‘airborne cancer’.

Bedaquiline, the anti-TB drug you were given on compassionate grounds, is now available in South Africa. Are there other promising developments in terms of TB treatment?
In December 2012 the South African Medicine Control Council (MCC) approved a national program to treat selected drug resistant TB patients with bedaquiline. This program began in March 2013. The program operated at five South African sites and was subsequently extended to twelve sites. In October 2014 the MCC approved the use of bedaquiline within the national TB programme.

You were an adviser for the World Health Organization post-2015 strategy to end TB and you’ve said that your dream is to see the disease eliminated in your lifetime. Is this possible?
I think it is, but it will require the combined efforts of governments, regulatory bodies, scientists, health-care providers and civil society. We need sustained government funding. We need better primary health-care infrastructure and an uninterrupted supply of treatment to patients. We need patient support. We do not need the stigma. Anyone can get TB, but every TB survivor can go on to make a valuable contribution towards society. Consider our greatest leader, Nelson Mandela – a TB survivor.

Published in Pulmonology

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