Challenge of diagnosing TB

The audio is in isiZulu. See the English summary below.

MABUTHO: Ngokujwalekile ukukhwehlela igazi kanye nokujuluka ebusuku kungezinye zezimpawu zesifo se TB. Kodwa ukuze kutholakale ukuthi umuntu uneTB kudingakala ukuthi kuhanjiswe isikhwehlela okanye igazi lakhe kuyohlolwa elaboratory. Imiphumela yeTB ejwayelekile ithatha isonto elilodwa kuya kwamabili ukuthi itholakale. Ngeshwa elikhulu kuyenzeka imiphumela ye TB ithathe isikhathi eside ngaphambi kokuthi itholakale ngenxa yezizathu ezithile. UViolet Gabashane usebenza njenge Laboratory Manager kwisikhungo esihlola iTB, iNational Health Laboratory Service (NHLS) eBraamfontein, eGoli. UGabashane uthi igciwane le HIV lingesinye sezizathu esenza ukuthi bangakwazi ukuthi basheshe bathole imiphumela ye TB.

 

VIOLET GABASHANE: IHIV uzokhumbula ukuthi ibulala amasosha omzimba. Manje uthole ukuthi umuntu uma ethola iTB ayikwazi ukuthi ingahlala nje ihlale emaphaphini. Iyakwazi ukuthi isheshe ingene kwezinye izindawo emzimbeni. So kwenzakalani uma kwenzeka kanjalo? Ama numbers ama TB ngaphakathi emaphashini ayehla. And uma emancane kakhulu kuba nzima ukuthi siwathole. Yikho futhi kwesinye isikhathi uthole ukuthi kufunakala igazi or ama fluid ngoba vele isuke seyigcwele umzimba wonke. Yikho ke kubanzinyana kubantu be HIV ukuba sithole imiphumela… Akusho ukuthi wonke umuntu okuthathwa igazi or ifluid usuke ene HIV. Kwesinye isikhathi uthole ukuthi iba kuma kidneys, ibe kuma joints, mhlawumbe ibe kwi brain noma umuntu enganayo i HIV.

 

MABUTHO: OkaGabashane uthi enye into enomthelela ukuthi iTB ingatholakali ngesikhathi ukuthi izikhwehlela abazitholayo elaboratory kwesinye isikhathi zisuke zingekho esimweni esifanelekile ngenxa yezizathu ezithile.

 

VIOLET GABASHANE: Kukhona abanye abantu abakwaziyo ukuthi balandele ama instructions bakhwehlele kahle kuphume kahle emaphashini. But abanye abakhoni. Omunye umuntu uvele akhafulele amathe. Uma kunjalo ke’€¦ kuba nzima ke ukuthi singathola ukuthi iTB ikhona. So, kusho ukuthi kubalulekile ukuthi umuntu athathe from emaphaphini’€¦ because kuzokwenza ukuthi kusheshe kutholakale kalula amaresults.

 

MABUTHO: UDr Natalie Beylis usebenza njenge Pathologist ezimele. Uthi kubaluleke kakhulu ukuthi imiphumela ye TB isheshe itholakale. Uthi lokhu kusiza ekunciphiseni ukuthelelana ngalesisifo ngoba uma isiguli sesitholakele ukuthi sine TB sisheshe siqale sidle amaphilisi. Uthi uma isiguli sesiqalile ukudla amaphilisi mancane amathuba okuthi sithelele abanye abantu ngalesisifo.

 

Dr NATALIE BEYLIS: It’€™s obviously very important that the tests that we use, are giving results very quickly. The sooner you diagnose a patient with TB, the sooner you can start treatment. And treatment obviously makes them better and decreases mortality. But also from the public health point of view, treatment will make that patient less infectious. And then you will be able to stop the spread of TB in the communities.

MABUTHO: UDr Tony Moll ungumphathi wesibhedlela iChurch of Scotland eTugela Ferry, eMsinga esifundazweni saKwaZulu-Natal lapho kwatholakala khona iziguli ezingu 53 ezabe zine Extensively Drug Resistant Tuberculosis. UDr Moll naye uyavumelana no Dr Beylis ngokubaluleka kokutholakala kwe TB kusenesikhathi. Uthi okwamanje kuseseyinkinga ukuthola iTB kusenesikhathi ikakhulukazi i MDR kanye ne XDR TB nokwenza ukuthi iziguli ezine TB eyejwayelekile zigcina sezihlanganiswe ndawonye nalezo ezine MDR kanye ne XDR TB.

 

Dr TONY MOLL: The most difficult thing is the long time it takes to actually diagnose MDR or XDR. And it’€™s not a bed side diagnosis. You can’€™t tell the difference between regular TB, MDR and XDR. It’€™s only when the laboratory has actually cultured the sputum and grown the TB organism and challenged it against the different drugs. To get a diagnosis  of XDR, it takes from six to eight weeks – and during that time, patients are mixed together.

 

MABUTHO: Njengoba ngokujwayelekile kuthatha izinsuku eziyisikhombisa ukuthola iTB ejwayelekile, uGabashane uthi kukhona ucwaningo olwenziwayo ukwenza ukuthi imiphumela yeTB  itholakale ngaphansi kwezinsuku eziyisikhombisa.

 

VIOLET GABASHANE: Umsebenzi wona usesemningi kwi TB ukuthi kuze kufinyelelwe ekutheni singathola ukuthola ama results ngaphansi kuka seven days. Kukhona iresearch esenziwa ukubona ukuthi’€¦ angeke yini sikhone ukwehlisa le seven days. But nayo ke isesemastejini asesephansi.

 

MABUTHO: Ngokwezibalo ze World Health Organisation (WHO) iTB iphatha abantu abayisigidi iphinde ibulale abantu abayizigidi ezimbili minyaka yonke emhlabeni jikelele. Uma imizamo eyenziwayo ukuthi imiphumela yeTB isheshe itholakale iba impumelelo lokho kuyosiza kakhulu ukuthi iziguli okutholakala ukuthi zine TB zisheshe ziqalise ukudla amaphilisi kanye nemithi ngesikhathi. Lokhu kuyosiza ukwehlisa izinga lokuthelelana nge TB.

See the English summary below.

Challenge of diagnosing TB

TB scientists say HIV infection and poor quality sputum specimens make it difficult to diagnose TB. This in turn contributes to the rapid spread of TB and drug resistance, especially in HIV-positive patients.

Night sweats, appetite loss and a bad cough are some of the symptoms indicative of TB. Normally, for TB to be diagnosed, a sputum or blood sample of a patient needs to be tested in a laboratory. The traditional method for laboratory diagnosis of TB normally takes seven to 14 days. But Violet Gabashane, Laboratory Manager at the National Health Laboratory Service (NHLS) in Braamfontein in Gauteng, says diagnosis can take longer if a patient is also HIV-positive.

‘€œYou will recall that HIV kills white blood cells. So now, you find that if the patient is HIV-positive and gets infected with TB, it does not stay in the lungs. It also spreads to other parts of the body.   So what does that mean? It means TB particles decrease from the lungs. And when they decrease, it becomes a problem for us to detect them. That is why it is not easy to diagnose TB from HIV patients,’€ she said.

Gabashane says another contributing factor to the delay in diagnosing TB is the poor quality of sputum that is sometimes sent to laboratories.

‘€œSome people are able to follow instructions carefully. But some don’€™t. Instead of coughing up sputum into the sample bottles, they just put in saliva.   So, in that way it becomes a problem to diagnose TB,’€ she said.

Dr Tony Moll is the Principal Medical Doctor at the Church of Scotland Hospital in Tugela Ferry in the Msinga area of KwaZulu-Natal, where 53 patients were diagnosed with Extensively Drug Resistant Tuberculosis in 2006. He says the delay in diagnosing TB, particularly drug resistant TB, can impede treatment and control efforts.

‘€œThe most difficult thing’€¦ is the long time it takes to actually diagnose MDR or XDR. And it’€™s not a bed-side diagnosis. You can’€™t tell the difference between regular TB, MDR and XDR. It’€™s only when the laboratory has actually cultured the sputum and grown the TB organism and challenged it against the different drugs. To get a diagnosis of XDR, it takes from six to eight weeks – and during that time, patients are mixed together,’€ he said.

Dr Natalie Beylis, a consultant pathologist, says there is a need to reduce the number of days that are spent on diagnosing TB.

‘€œThe sooner you diagnose a patient with TB, the sooner you can start treatment. And treatment obviously makes them better and decreases mortality. But also from the public health point of view, treatment will make that patient less infectious. And then you will be able to stop the spread of TB in the communities,’€ she said.

Gabashane says there is research underway looking at decreasing the number of days it takes to diagnose TB. However, ‘€œit is still in its early stages’€, she added.

According to the World Health Organization (WHO) statistics TB infects one million and kills an additional two million people world-wide every year.

 

 

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