Tuberculosis

Tuberculosis (TB) is one of the most deadly infectious diseases in the world. Each year it kills 1.4 million people with nearly another nine million suffering from the disease, mainly in developing countries.

TB is often thought of as a disease of the past but a recent resurgence and the spread of drug-resistant forms makes it very much an issue of the present day and age. Today, TB is one of the three main killer infectious diseases, along with malaria and HIV/AIDS.

One-third of the world’s population is currently infected with the tuberculosis (TB) bacillus but they have a latent form of the disease and so have no symptoms and cannot transmit it. In some people, the latent TB infection progresses to acute TB, often due to a weak immune system. Every year, about nine million people develop active TB and 1.5 million die from it.

TB is the major killer of people living with HIV in Africa. Almost half a million people develop multi drug-resistant strains of the disease every year.

Though the global death rate from TB dropped more than 40 percent in in the years between 1990 and 2011, there are still crucial gaps in coverage and severe shortcomings when it comes to diagnostics and care options.

Furthermore, we are currently seeing an alarming rise in cases of drug-resistant and multidrug-resistant tuberculosis (DR-TB and MDR-TB) that do not respond to the customary first-line drugs.

MSF has been fighting TB for over 30 years. We provide treatment for the disease in many different contexts, from chronic conflict situations, such as Sudan, to vulnerable patients in stable settings such as Uzbekistan and the Russian Federation.

Hover over the image below for an interactive guide to TB

What causes TB?

TB caused by a bacterium (Mycobacterium tuberculosis) that is spread through the air when infected people cough or sneeze.

The disease most often affects the lungs but it can infect any part of the body, including the bones and the nervous system.

Most people who are exposed to TB never develop symptoms, since the bacteria can live in an inactive form in the body, but if the immune system weakens, such as in malnourished people, people with HIV or the elderly, TB bacteria can become active.

Around 10 percent of people infected with TB will develop active TB and become contagious at some point in their lives.

Symptoms and diagnosis

The disease most often affects the lungs. Symptoms include a persistent cough, fever, weight loss, chest pain and breathlessness in the lead-up to death. TB incidence is much higher, and is a leading cause of death, among people with HIV.

The research and development (R&D) of new, more effective diagnostic tools and drugs for TB have been severely lacking for decades.

In countries where the disease is most prevalent, diagnosis has depended largely on one archaic test for the last 120 years – smear microscopy, the microscopic examination of sputum, or lung fluid, for the TB bacilli.

The test is only accurate half of the time, even less so for patients who also have HIV. This means that too many patients start treatment late, if they start it at all.

Children, who often cannot produce sputum, urgently need a new diagnostic tool, especially since they are particularly vulnerable to dying if they develop active TB.

A promising new diagnostic test, Xpert MTB/RIF, was introduced in 2010 and MSF has used it in many of its programmes since. It’s not applicable to all settings, nor is it effective for diagnosing children or patients with TB that occurs outside of the lungs (extra-pulmonary TB), so MSF continues to call for further R&D in diagnostics for TB.

Treatment

A course of treatment for uncomplicated TB takes a minimum of six months.

When patients are resistant to the two most powerful first-line antibiotics (isoniazid and rifampicin), they are considered to have multidrug-resistant TB (MDR-TB). MDR-TB is not impossible to treat, but the drug regimen is arduous, taking up to two years and causing many side effects.

Extensively drug-resistant tuberculosis (XDR-TB) is identified when patients show resistance to the second-line drugs administered for MDR-TB. The treatment options for XDR-TB are very limited. Two new drugs – bedaquiline and delamanid – have recently become available to some patients who have no other treatment options left. However, in the two years since they were conditionally approved for use, only 2% of the 150,000 people who need them have been able to access them.

In many places where we work, supervising all TB patients during their treatment is difficult to impossible. So, to help patients complete their treatment, MSF has introduced more flexible strategies.

MSF treated 18,100 patients for TB, of which 2,000 for MDR-TB in 2015.

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