This fact sheet explains what Multi-Drug Resistant TB is and provides information on its treatment and prevention.
Multi-Drug Resistant TB, like "Ordinary" TB, can be prevented and treated. Early presentation to a local health facility and adherence to prescribed treatment will prevent further spread of the disease.
Encourage everyone who is coughing for more than 2 weeks to be tested for TB and everyone on treatment to complete their treatment.
What is MDR TB?
How many people in the Western Cape Province are affected with MDR TB?
What causes MDR TB?
Can someone develop MDR TB without ever having been infected with "ordinary TB"?
Who is at risk of contracting MDR TB?
Is it easier to get MDR TB Is MDR TB more infectious than "ordinary" TB?
What are the symptoms (complaints) of persons with MDR TB?
How is MDR TB diagnosed?
How can the spread of TB be prevented (including MDR TB)?
Can a person with MDR TB continue to work, and if not, are they eligible for a disability grant?
Is there a link between HIV/AIDS and MDR TB?
Can an HIV infected person or person living with AIDS take both MDR TB and Antiretroviral treatment at the same time?
What is meant by an "outbreak" of MDR TB?
In the case of an outbreak of MDR TB, how is further spread of the infection prevented?
Multi-Drug Resistant TB (or MDR TB) is a form of TB caused by bacteria (germs) that are resistant to the usual drugs used to treat "ordinary" TB. In other words, the normal drugs that we use to treat "ordinary" TB will not work.
The Western Cape Province has relatively low rates of MDR TB, compared to other provinces and elsewhere in the world.
Of all people who are diagnosed with TB for the first time, 1% (1 in 100) will have MDR TB, and of all people who are diagnosed with TB after having been treated for TB before, 4% (4 in 100) will have MDR TB.
The World Health Organization (WHO) ranks South Africa the 9th country in the world who notifies the most number of TB cases every year.
This means that although the rates of MDR TB are low in the Province, there is still a large number of people diagnosed with MDR TB in the province each year.
On average between 450 and 600 new cases of MDR TB are diagnosed in the Western Cape annually.
MDR TB is caused by the development of TB bacteria, which have become resistant to ordinary TB drugs. This occurs as a result of inadequate or irregular management of "ordinary" TB, either by using inappropriate drug combinations or by using single drugs for "ordinary" TB, clinics running out of drug stocks, inadequate counseling of patients leading to patients not taking their treatment correctly (poor treatment compliance) or patients not returning for treatment (defaulting treatment).
Most MDR TB will develop as a result of poor adherence to the treatment for "ordinary" TB; however it is possible for someone who has never had or been treated for TB before to be infected with bacteria that are already resistant to ordinary TB drugs, if they have had close contact with someone with MDR TB.
Anybody who is exposed to someone with MDR TB may be at risk of developing it. Most people who have strong immune systems will not develop the disease, as their body's immune system can fight the infection.
People who are at greater risk of developing "ordinary" TB are also at greater risk for MDR TB.
Persons whose immune systems are not strong due to other diseases e.g.
Persons with substance abuse problems e.g. alcoholism or drug abuse.
There is no evidence to suggest that it is easier to get MDR TB than ordinary TB.
TB of the lungs is relatively more infectious than TB affecting other organs/ systems of the body, as the bacteria may be excreted and spread by air-borne droplets.
A persistent cough for longer than 2 weeks.
The cough may be productive and blood stained, chest pain, loss of weight and loss of appetite and night sweats.
Once a person presents with symptoms of TB, or is found to be a close contact of somebody with TB, clinic staff will request the person to provide two sputum (spit) specimens (phlegm from coughing), which will be sent to the laboratory for testing under a microscope. In addition to the normal tests done for TB, additional tests called culture and sensitivity testing, are done on the sputum specimens of people suspected of having MDR TB. These specialized tests take three to four weeks to reveal growth of the resistant TB bacilli, and to see which drugs will work against the bacteria. In addition, chest X-rays may be done in certain circumstances to see the extent of any lung damage and for future monitoring of response to treatment.
Can patients with MDR TB be treated and cured?
MDR TB is more difficult to treat than ordinary TB, because the TB bacilli are resistant to the drugs used to treat ordinary TB. "Second line" TB drugs are used, which are less effective and have more side effects. Treatment outcomes are not as good as those with drug sensitive TB, partly because MDR TB tends to occurs in people with extensive lung damage who have been on and off TB treatment a long time. If diagnosed early the chances of cure are much better. On average, less than 50% of people with MDR TB will be cured, and about 30% will die before completing treatment.
How is MDR TB treated?
Patients with MDR TB will have to take at least 5 different drugs, including a daily injection for 4 months 5 days a week. During this time most patients with MDR TB are admitted to hospital so that they can be closely monitored for adherence to treatment and to monitor any side effects.
Thereafter patients will need to take at least 3 different drugs for a further 12 - 16 months 5 days a week.
Thus, treatment is much longer than for "ordinary TB" (which takes between 6 to 8 months), and can go on for up to 2 years. The length of treatment is to ensure that the disease does not relapse.
When coughing or sneezing, any person and especially those with TB or MDR TB should cover the nose and mouth with a tissue to prevent air-borne spread of the bacilli. Patients should also avoid spitting into open air/ the ground. Good ventilation of households is strongly recommended, people are encouraged to keep all windows and doors open. If possible limit prolonged contact (includes avoiding sharing the bedroom at night) with persons with ordinary TB or MDR TB, while their sputum remains positive with TB or MDR TB bacilli.
When the patient is taking treatment regularly and once the sputum has been tested and shows that they are no longer excreting MDR TB bacilli, the person can resume working. This usually takes longer than the usual period of 2 weeks as with "ordinary" TB. The doctor and TB nurses will monitor the patient closely and will inform the patient when they can go back to work. If the patient is assessed and declared to be "physically incapacitated" by a medical doctor, they may apply for a temporary disability grant.
People who are HIV positive are more susceptible to ordinary TB. There is no evidence that HIV positive people are more susceptible to MDR-TB than to ordinary TB.
Infection with TB also increases illness and progression (morbidity) of HIV, including increasing the death rate (mortality) in HIV infected people. Thus it is extremely important for TB to be prevented and/or detected and treated as early as possible in HIV infected people.
It is important to remember that even if someone is HIV positive TB can be treated and cured!
The two treatments may be taken concurrently. Close monitoring by an experienced medical doctor is necessary for patients on both therapies.
By definition any disease outbreak is the occurrence of more cases of the particular condition than would normally be expected in the particular circumstances. The disease cases must be epidemiologically linked (that means that medical staff are able to establish definite links between the cases), as opposed to occurring by coincidence.
Once an MDR TB case is suspected, active case finding is undertaken, i.e. we actively look for all persons who may have contracted the infection before they present ill to health facilities. This is done to limit the potential spread of the infection by as yet undiagnosed persons. Sputum tests for MDR TB are done and appropriate treatment is offered to confirmed cases.
At the same time, these persons should be removed from the community until they have received treatment and are no longer infectious.