TB: Treating a disease that can fight back even harder

Dr Gabriel Fitzpatrick has seen how Médecins Sans Frontières is helping the people of Swaziland battle a killer disease which infects a third of the world's population

Our grandparents used to call it consumption, a disease that slowly hollowed out a loved one. Today, tuberculosis, or TB, continues to infect 9m people a year globally. An estimated 1.5m die from the disease each year.

The majority of cases are in low- and middle-income countries. These figures, although large, represent an overall improvement in the global burden of TB during the last decade. But there is a caveat. A worrying development is the growing proportion of patients who are infected with a type of TB that is resistant to standard treatment, known as multi-drug resistant (MDR) TB.

The World Health Organisation estimates there were almost 500,000 cases of resistant TB in 2013 alone. Ominously, certain TB is now so resistant to treatment that it is called extensively-drug resistant (XDR) TB.

Normal tuberculosis can be successfully treated with four drugs given over six months. Resistant strains require at least five different drugs to be taken for up to 20 months. The problem with the resistant TB treatment is that it has serious side-effects.

TB: Treating a disease that can fight back even harder

One of the drugs must be injected daily and can cause deafness, while others lead to distressing gastrointestinal problems and can damage certain organs of the body. The most common form of the disease is lung TB, and a person can spread it by coughing or talking to another person within confined spaces. It goes without saying, it is in everyone’s interest to help societies with high levels of TB as it represents a potential threat to all countries.

Médecins Sans Frontières, which is better known for fighting ebola, has been committed for years to treating TB patients in countries with a high burden of the disease. One such country is Swaziland in southern Africa, with a population of just over 1m people.

Last year, it had approximately 7,000 cases of tuberculosis. Here, MSF operates dedicated hospital wards and clinics for all types of TB. On our ward round this week, there are many patients, each with their own story of how TB has affected their lives.

A 40-year-lady sat up in bed smiling. She has the resistant type of TB (MDR). Two weeks ago she partially lost her hearing as a side-effect from one of the drugs and is now using her hands to communicate. Doctors and nurses are faced with the difficult dilemma of using drugs with very serious side-effects in order to cure patients of a disease which can kill them.

Risks are always explained to patients. A woman in her 20s with resistant TB in the next ward had a sheet over her head. She has just died. She turned up to the hospital with very advanced TB, too late to have a fighting chance of survival, even with the cocktail of drugs available.

TB: Treating a disease that can fight back even harder

One of the most intimidating wards is that of the XDR cases. Here, patients are treated with drugs that form the last line of defence against the disease. Thankfully, these patients appear to be tolerating their treatment at the moment but this situation can change quickly.

At all times while working on the ward, staff wear specially fitted masks that prevent us from inhaling TB. This forces us to use our eyes to smile at patients. The vast majority of those treated for TB have a successful outcome because they are given the right drugs at the right time and for the correct duration.

MSF is testing a new combination of medications for MDR TB that can be given over the course of nine months instead of the current 20 months, the results of which will become available at the end of next year.

If successful, this will dramatically shorten the amount of time patients need to take these potent drugs leading to greater compliance and reducing the opportunities for TB to mutate into ever more resistant strains.

However, what is really needed to win the battle against this disease are new drugs that are more active against TB over a shorter duration of time.

This requires research on a much larger scale than is currently the case.

Dr Gabriel Fitzpatrick has just returned from Swaziland where Médecins Sans Frontières/Doctors Without Borders operates dedicated hospital wards and clinics to treat all forms of tuberculosis.

For more, see msf.ie

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