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Tuberculosis (TB) is one of the most deadly infectious diseases in the world. Each year, TB kills 1.6 million people, and nine million are diagnosed with the disease, mainly in developing countries.

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.

In 2012, MSF admitted 29,000 new patients for first-line TB treatment and 1,780 for second-line treatment.

TB is often thought of as a disease of the past but a recent resurgence and the spread of drug-resistant forms have made it an urgent public health issue. 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 more than 40 per cent 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 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 like Sudan, to more stable settings like Uzbekistan and the Russian Federation where vulnerable patients depend on MSF for treatment.

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. But if the immune system weakens, such as in malnourished people, people with HIV or the elderly, TB bacteria can become active. Around 10 per cent of people infected with the bacteria 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 among people with HIV, and is a leading cause of death.

Diagnosing TB

The research and development (R&D) of new, more effective diagnostic tools and drugs for TB has 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 — the microscopic examination of sputum for the TB bacteria.

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. 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.

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. Extensively drug-resistant tuberculosis (XDR-TB) is identified when resistance to second-line drugs develops. The treatments for XDR-TB are limited.

In 2012, MSF admitted 29,000 new patients for first-line TB treatment and 1,780 for second-line TB treatment.