Survivor’s tough struggle with drug-resistant TB
Pride Macala is one of the lucky ones. After being hospitalised for eight months and a further year of drug-taking, she no longer has multi-drug resistant TB, which only has a 55% cure rate nationally.
Macala first contracted TB in 1999 but at first her clinic simply gave her cough mixture. On her second clinic visit, weighing a mere 34kgs, she was diagnosed with TB and given treatment.
But three months after she had completed her treatment, the TB came back.
‘This time it was so severe that I was coughing out blood. I was vomiting blood. They took me back on treatment, but I did not recover,’ says Macala.
Her sputum (mucus) was sent to Johannesburg to be cultured, and was found to be multi-drug resistant. She was then admitted to the MDR referral unit at Klerksdorp Hospital in the North West.
‘I had a lot of side-effects. My eyes were itching. And I had a heart problem. They had to give me treatment that drains the water out of my body because I was so swollen. I had nausea. I had irregular heart-beats. I had short breath.’
Dr Marisa van Rensburg, who heads the unit, explains that the symptoms for MDR TB are the same as for regular TB but the patient doesn’t respond to normal TB treatment.
Around 4% of TB cases in the North West are MDR, says van Rensburg.
At her facility, 207 patients have completed the MDR treatment and 58% were cured.
Over 45% of the patients were also HIV positive, and 58 have since died, mostly from AIDS-related diseases.
Seven are resistant to all the drugs and, says Van Rensburg, ‘we don’t have anything to offer them because there are no new drugs on the market’.
‘The treatment is 16 to 20 months. The first four months is the intensive phase. We give five drugs. I call them the Big Five.
‘The most important is an injection we have to give for four months from Monday to Friday. I usually tell the patients that the head of the Big Five is the lion ‘ the injection. His bite is the worst.’
During the first four to six months, patients are hospitalised both because of the many side-effects of the drugs that need to be monitored and because they are contagious and pose a danger to others.
To prevent the spread of infection, patients are locked into the ward. They can only see visitors in the garden.
‘It’s not easy, to tell you the honest truth. Emotions were so high and I’m in this cage away from my family,’ says Macala, who today does support work among MDR TB patients, trying to encourage them to keep strong.
After four months, the injections stop and patients go from five to three drugs for the rest of their treatment, which is at least another year.
Macala’s teenage daughter also contracted MDR TB, but she too has since been cured. However, there is no treatment for babies as the drugs are too toxic for them to take.
‘After completion of their treatment they come every three to six months for follow up for the next five years,’ says Van Rensburg.
‘Our default rate is very, very low. Only eight patients defaulted. I think it’s the very good team work that we have with the different districts.
‘Every district has to bring their patients monthly to the clinic. They know their names. They must collect them and bring them here.’
Basic TB facts
¨ TB is a bacterial infection that is highly contagious. It is passed on through infectious droplets when a person coughs or sneezes.
¨ Symptoms include fever, night sweats, weigh loss and coughing, including coughing up blood.
¨ TB usually infects the lungs (pulmonary TB), but can infect any organ in the body.
¨ Many South Africans have latent TB. This means that the bacteria is not eliminated but rather quarantined by a barrier of immune-system cells that prevent the bacteria from growing and spreading.
¨ This barrier breaks down when people have weakened immune systems, which is why TB is common in people with HIV.
¨ TB is diagnosed from the sputum (coughed up mucus) of the patient. A smear is made from the sputum and checked under a microscope to see whether there are any TB bacilli. If there are many bacilli, this is classified as Stage 3 TB and the patient is described as being smear positive. This means that a person is contagious.
¨ A culture should be grown from the smear positive sputum tests to tell whether their TB is still active (the microscope examination cannot tell whether the bacilli are dead or alive which is why the culture is important.)
¨ MDR TB can only be diagnosed once a culture is grown and then exposed to different TB drugs to see whether it reacts or is immune (resistant) to the drugs. It takes around four to six weeks to grow this culture.
¨ TB treatment involves taking four different drugs every day for six months. The four drugs have been combined into one pill and the treatment costs around R300 for the entire course.
Failure to complete the six-month course makes a person vulnerable to multi-drug resistant TB, which is extremely difficult to cure.
E-mail Khopotso Bodibe
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