Tuberculosis (TB) is caused by the organism mycobacterium tuberculosis. It is very common in South Africa, particularly in area where it is associated with overcrowding and malnutrition.

It can affect any organ system in the body, but tends to be a disease of the lungs.

The main symptoms of TB in an adult are a cough, sometimes coughing blood, night sweats, loss of weight, loss of appetite and tiredness.

Other, less common, symptoms are a rash on the front of the legs and a variety of other manifestations which arise when TB affects organs other than the lungs.

Different in kids

Children generally do not have the so-called adult form of TB in which the lungs are the main organ system affected, and are much more difficult to diagnose. They will present with failure to grow and possibly enlarged glands in the neck.

They may also present with symptoms of obstruction to their breathing if glands in their chest become enlarged and block the airways. This is primary TB. They can also present with a TB effusion, or fluid, on the lungs and may also have TB in other parts of the body.

In adults?

Diagnosis in an adult is made after seeing the organism in a sputum specimen and, often, a characteristic apearance on chest X-ray. In children the diagnosis is generally made by a combination of a postive skin reaction to a Mantoux test and the physical symptoms and signs described above.

A negative Mantoux in a child does not mean that they do not have TB, since a malnourished, ill child will not mount the immune response necessary to give a postitive skin test.

TB is actually not an easy disease to catch, and tends to occur in those who have a depressed immune system for some reason such as malnourishment or HIV infection. It is transmitted best in overcrowded conditions and cannot be contracted by casual contact with someone who has the illness, nor can it be passed on by sharing eating utensils used by someone with TB. Once a person is on anti-tuberculous treatment they are no longer infectious.

In South Africa TB is a notifiable disease and is best treated at one of the many local authority or municiple clinics which have specially trained staff.

Adults who have not had TB are treated over six months, with different drug combinations in the first two months and again in the last four months of treatment.

Adults who have had TB before are treated for a total of eight months. In both cases treatment is daily and must be observed by a responsible person who will ensure that the patient is taking their drugs correctly.

Children with primary TB are treated for four months with different drugs in each two month period. Those with a more complicated form of TB are treated for six months. Again, treatment must be supervised daily.

If TB treatment is not taken daily for the full period then there is a danger of the TB organisms becoming resistant to the normal anti-tuberculous drugs, resulting in so-called multi-drug resistant TB which is a major problem to treat, and is, in some cases, incurable.