During 2021, the Tuberculosis (TB) mortality rate increased for the first time in over a decade. Experts believe that the fight against TB was set back by a number of years as a result of the COVID-19 pandemic.

The Global Tuberculosis Report published in 2021 and 2022 describes the negative impact of the pandemic on the targets set out by the World Health Organisation’s (WHO) End TB Strategy.

March is tuberculosis awareness month, and March 24 is World TB Day.

TB is the leading infectious disease killer in the world. In South Africa, more than 300 000 people contract the disease each year, and on average there are 180 deaths per day. 

WHO estimates that a quarter of the world's population is infected with the bacterium that causes TB known as Mycobacterium tuberculosis (M.tuberculosis). However, not all infected people will become sick with TB. Generally, people with a weakened immune system are at a higher risk of developing TB.

In most cases, TB affects the lungs (known as pulmonary TB), and symptoms include coughing up blood and mucus over several weeks, chest pains as well as losing weight and sweating at night. TB may also affect other organs, such as the stomach, the skin, the brain and the bones. In South Africa a diagnosis is made following an examination by a doctor and analysis of a sputum sample for the presence of the bacteria.

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TB can be treated. Persons ill with TB are given a combination of antibiotics which they should take for at least six months. Unfortunately, taking these antibiotics is not easy as some medicines have unpleasant side effects. Drug resistant strains may develop, especially in cases where patients have not adhered to the antibiotic treatment regimen. Treatment of drug resistant strains of M.tuberculosis is much more difficult and requires the use of special antibiotics and treatment for a longer period of time which may be up to two years in duration. There is a need for safer and effective antibiotics or new treatment approaches to cure all forms of TB.  

There are a number of ongoing research and development activities at the University of the Western Cape (UWC) aimed at tackling TB-related issues. At the School of Pharmacy researchers are working to discover new, effective and safer drugs for killing M. tuberculosis, including drug-resistant strains. Some of the potential new drugs come from the bottom of the sea, and some from South African traditional herbal medicines.

Cutting edge bioinformatics tools and artificial intelligence are being used to discover new drugs and to predict their safety and effectiveness. In the School of Pharmacy, researchers are also employing nanotechnology to deliver antibiotics to the infected sites and to develop new treatment approaches based on immunotherapy. These activities are aimed at providing treatments for patients that are more effective against all strains of the bacteria, that are safer and are of shorter duration. There’s also work being done at the School of Pharmacy to improve the understanding about how patients can adhere to their treatment, and potentially reduce adverse long-term effects of the medicines. Various clinical programmes focus on improved care for patients with TB, either within the primary healthcare sector or hospital sector. Research has been undertaken on the potential role of the pharmacist in screening and detecting potential patients with TB as part of a care package provided by pharmacists.

Undergraduate and postgraduate students are actively involved in this research as part of their training.

As we recognise World TB day, we should remain supportive of patients undergoing TB treatment and be cognisant of the future hope for better treatment and management of this disease offered by ongoing research and development activities. As a School of Pharmacy, we aim to accelerate the End TB Response – or the end of the pandemic - to reach the targets set in the Sustainable Development Goals, the WHO End TB strategy, the Moscow Declaration to End TB and the political declaration of the United Nations High-Level Meeting on TB.

Frequently Asked Questions about TB

What is TB and how is it spread? TB is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis. The bacteria is spread through the air from one person to another. If a person with TB disease of the lungs coughs or speaks, people nearby may breathe in the bacteria and become infected. Unlike viral diseases like the Coronavirus, TB does not spread by shaking hands, touching door handles, sharing food, or even kissing, as the bacteria has to be airborne and breathed into the lungs to cause TB infection. People with TB disease are most likely to spread it to people they spend time with daily (e.g. family members, friends, co-workers and schoolmates).

What are the symptoms of TB disease? The most common type of TB disease is an infection in the lungs, although it can spread to many different parts of the body, e.g. the stomach, knees, kidneys or brain. TB infection outside the lungs is referred to as extrapulmonary TB. A patient with TB disease of the lungs will likely cough regularly for longer than three weeks (sometimes with blood in the sputum), may experience fever and night sweats, and may lose weight without trying.

How is TB diagnosed? To test for TB, a healthcare worker will take a sample of sputum and use GeneXpert to detect the presence of the bacteria and which medicines the bacteria is sensitive to. Culturing of bacteria or observation under a microscope may also be performed to confirm infection.

Can TB be cured? Various medicines can be used to treat TB. A person who has developed TB will be given a combination of four medicines which have to be taken regularly for six months. If there are no complicating factors like HIV or drug resistant TB, most patients become sputum negative (show no bacteria in sputum and will now not transmit TB) after two months of treatment, and will be cured of TB after six months. Taking TB treatment is unfortunately not easy as the medicines have many (sometimes permanent) side effects. Last year, South Africa made international headlines after negotiating a drastic cut in the price of a relatively new once-weekly, three-month course to prevent TB. As a country, we are a few months ahead of an anticipated national rollout of the drug combination, also known as 3HP. This will protect high-risk patients, e.g. people living with HIV, children and cancer patients, from contracting TB. 

Prevention of TB? All children receive the Bacille Calmette-Guerin (BCG) vaccine at birth in South Africa. This is a live vaccine given to stimulate the baby's immune system to build antibodies to protect against TB. However, this vaccine is unreliable in protecting against TB infection in the lungs. People with TB disease are advised to cover their mouth or nose when they cough or sneeze, and when living with a person with TB, one should maintain fresh airflow in rooms by opening windows.

What is drug-resistant (MDR) TB? Drug resistance happens when bacteria change in ways that stop the medicines used to treat it from working. A person who gets infected by a drug resistant strain of mycobacteria develops MDR-TB. Patients with MDR-TB are treated with a different combination of medicines, commonly referred to as second-line drugs. Most often, one of the combinations of drugs is an injectable agent. Patients have to find ways to receive the injection daily for at least two years. In 2018, South Africa became the first country in the world to make MDR-TB treatment more tolerable and reduce the devastating impact of side effects caused by injectable agents by introducing bedaquiline as an oral treatment. Experience with the drug bedaquiline in treating MDR-TB, mainly from South Africa, demonstrated improved health outcomes for patients with MDR-TB. Many researchers are working hard to find new drugs that work better, have fewer side effects, and can kill drug-resistant TB.

DID YOU KNOW?
Prof Admire Dube is one of five NRF-rated researchers at UWC's School of Pharmacy. The others are Prof Sarel Malan, Prof Denzil Beukes, Prof Jacques Joubert and Prof Marique Aucamp.