Known throughout history as consumption, the white plague or hectic fever, tuberculosis kills more people today than ever before, and the numbers aren?t getting any better.

In fact, two billion people, or one third of the world?s population, are infected with latent tuberculosis. Ten percent of those infected will develop active TB within their lifetime, according to Dr Lee Reichman, Executive Director of the National Tuberculosis Centre at New Jersey Medical School in the United States.

Reichman, who was in Cape Town last month to attend the annual board meeting of the international Global Alliance for TB Drug Development, has said that tuberculosis is expected to kill 30 million people over the next decade. ?Worse yet, this ancient disease is undergoing a metamorphosis, adapting to our misused medications, growing stronger, becoming unbeatable ? becoming multi-drug resistant?, Reichman is quoted as saying in his book entitled 'Timebomb ? The Global Epidemic of Multi-Drug-Resistant Tuberculosis'.

Multi-Drug Resistant Tuberculosis (MDR-TB) is a strain of tuberculosis that often develops in patients who do not comply with the prescribed treatment for TB.

?The general treatment for tuberculosis requires patients to take a range of antibiotics every day for between six and 18 months. What often happens, either due to lack of compliance by patients or lack of medical supplies or assistance, is that treatment is discontinued after a few weeks or months, or as soon as the patient starts to feel better. This causes an increase in resistant bacteria, which can develop into MDR-TB,? says Dr Kennedy Mubaiwa, Medical Director of Eli Lilly South Africa, the pharmaceutical company who recently joined forces with Aspen Pharmacare to produce antibiotics to fight MDR-TB in areas around the world where it is most rife.

Once a strain of MDR-TB develops, it can spread to others just as ?normal? TB. MDR-TB is most likely to occur among patients in developing nations where trained medical personnel and drug supplies are limited. Each year, roughly 300 000 new cases of MDR-TB occur in more than 100 countries. The WHO estimates that an average MDR-TB patient infects up to 20 other people in their lifetime.

?Though little known, MDR-TB represents one of the most severe threats to public health today. Without proper treatment and surveillance now, MDR-TB can easily become a global health emergency in years to come?, says David Heymann, executive director of communicable diseases at the World Health Organisation (WHO).

Reichman warns of the devastating impact that uncontrolled TB, and specifically MDR-TB, can have: ?It percolates in hot spots all over the globe, from Brazil to China, from India to Russia? and every day, international flights touch down on the doorstep of the Western world, potentially carrying the deadly disease into small towns and bustling metropolises?. Multi-drug resistant TB spreads the same way regular TB does, through the air.

?It travels with people, whether they are government officials, investment bankers, smugglers or illegal immigrants? says Reichman.

Because of the stigma associated with TB, sufferers are often reluctant to discuss it, yet many high-profile people both in South Africa and beyond have suffered from TB. Early in the last century, TB killed Eleanor Roosevelt and all five of the Bronte sisters. American superstars Tina Turner and Ringo Star have both had TB. Closer to home Nelson Mandela suffered from TB while in prison and was hospitalised because of it in 1988. Other well known local personalities to have contracted and beaten TB include Desmond Tutu, Margaret Gardiner and Gerry Ransteli.

TB Facts

How TB Spreads:

Much like any contagious disease such as the common cold, TB can be spread when a person talks, sneezes, coughs or spits. These actions release small droplets which contain bacilli germs into the air, which if inhaled, can infect other people.

A person with a strong immune system is able to fight the bacteria and prevent the disease from becoming an active infection. The TB bacilli will then lie dormant for weeks, months or even years, and can develop into an active infection when the immune system is weakened.

Signs and Symptoms:

The following are symptoms of active tuberculosis:

  • A cough which lasts longer than 3 weeks or more
  • Phlegm which may contain blood
  • Fever and night sweats
  • Tiredness
  • Loss of appetite
  • Loss of weight.

    Diagnosis:

    If the symptoms above are present and TB is suspected, the most common test which may be conducted to confirm the presence of the disease is a chest X-Ray which can depict signs of TB in the lungs.

    Treatment:

    TB is a curable disease if it is caught and treated properly, and deaths caused by TB are very preventable. When the disease is in its active stage, it can be quite easily treated with antibiotics. It is a lot more difficult to treat in its dormant or resistant phase. MDR-TB costs at least 100 times more to treat than normal TB. This is a huge financial burden in countries where MDR-TB is prevalent.