Primrose and her child Panashe as doctors confirm the seven-year-old boy is suffering from TB.
ZIMBABWE 2011 © Brendan Bannon
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Tuberculosis (TB) is one of the most deadly infectious diseases in the world. Each year it kills 1.5 million people with nearly another nine million suffering from the disease, mainly in developing countries.

In 2015, Doctors Without Borders/Médecins Sans Frontières (MSF) treated 20,100 patients for tuberculosis. And MSF is also trying to bring attention to the growing problem of drug-resistant tuberculosis, or DR-TB, in part by asking people to sign its DR-TB Manifesto calling on more research and better medications to assist patients enduring the disease.

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.

Though the global death rate from TB dropped 45 percent in the years between 1990 and 2013, 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.

What Causes TB?

TB is 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 of TB

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.

Diagnosing TB

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 programs 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.

Treating TB

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 (rifampicin and isoniazid), they are considered to have MDR-TB.

MDR-TB is not impossible to treat, but the drug regime is arduous, taking up to two years and causing many side effects. XDR-TB is identified when resistance to second-line drugs develops on top of MDR-TB. The treatments for XDR-TB are limited.

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 20,100 patients for tuberculosis in 2015, of which 2,000 were MDR-TB cases.