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Sunday marked World Tuberculosis Day. While T.B. doesn’t attract the same attention as influenza, malaria or Ebola, it recently surpassed HIV/AIDS to become the globe's leading infectious killer. In 2018, there were more than 10 million new cases. There hadn’t been a treatment breakthrough for 40 years, but the tide is starting to turn. Hari Sreenivasan shares a story of hope from South Africa.
This past Sunday marked World T.B. Day, as tuberculosis recently surpassed HIV/AIDS to become the leading infectious killer in the world, with more than 10 million new cases last year.
Hari Sreenivasan reports, there are new hopes for treatment.
Dalene von Delft was leading a happy life. The young South African physician was married to a classmate from medical school, and well on her way to being a pediatric surgeon, when she got what felt like a bad cold, including a cough that wouldn't go away.
Dr. Dalene Von Delft:
I think I just decided, before the end of the year, I must go for an X-ray.
I can remember walking into the dark room and just seeing my X-ray, and I got such a fright. I could see the whole left top part of my lung was just — it was a hole, and it was just destroyed. And I couldn't believe it's my X-ray, because it looked bad.
It was tuberculosis, or T.B., a contagious bacterial infection that most commonly attacks the lungs. It spreads from person to person through the air, through coughing or speaking. For Dalene, the news was even worse.
I was at home. This e-mail came through, unfortunately, with the news that I got multidrug-resistant T.B.
For Zolelwa Sifumba, it started with a swollen lymph node when she was still in medical school.
Dr. Zolelwa Sifumba:
There's a certain way T.B. looks when it's in your lymph node.
So, the doctor, who knew I was a medical student, turned it into a lesson. He was like, "Hey, do you know what caseous necrosis is?"
And I was like, "T.B."
And then he's like, "Yes, you have got it."
Then, on a Saturday morning, I got a phone call. They said: "Now, look, your results have come back. You have got MDR."
Multidrug resistant T.B., or MDR, is especially dangerous. Properly treated, T.B. is curable, but the antibiotics that usually do the trick don't work against MDR.
The strain has evolved to be resistant against standard drugs. Even with the best of care, there were no guarantees.
Meaning there was a 40 percent chance that I was going to die.
Neither Zolelwa nor Dalene knew exactly how or when they'd been infected, but doctors who work in hospitals, around sick patients, are at higher risk.
The MDR treatment was grueling, more than 20 pills a day, as well as daily injections that cause devastating side effects, nausea, vomiting, exhaustion, brain fog and 50 percent chance of permanent deafness.
I absolutely love music, and I have always been playing piano and listening to music. And I used to sing in choirs, and we used to win national competitions. I couldn't imagine a life of silence.
Von Delft's hearing was fading, the price of the injections that were saving her life. Her husband, Arne, recalls the excruciating choice.
Arne Von Delft:
I mean, when Dalene was starting to lose her hearing, the first doctor said, "Well, it's deaf or dead." But deaf or dead is not a fair choice, and it's the treatment that causes it, not the disease.
Zolelwa Sifumba, the medical student, was receiving the same painful injections.
Pain from the injection, I would describe it as hot lava being injected into you. It's difficult to sit, to stand, to sleep, to walk.
Thoughts of suicide are common.
There wasn't a day that went by that I didn't think about killing myself.
As tough as it is, the treatment can save lives. but many patients are never properly diagnosed. Others can't find the drugs, or they're too expensive.
And many can't stick to such a long and rigorous treatment. Worldwide, only one in four people with MDR receives proper care.
I realized, as a white South African doctor, I had access to the best treatment. I realized how extremely lucky I was.
Dalene's luck began to turn when, through a special research program, she was able to receive a new medication. Bedaquiline was the first significant new T.B. drug in 40 years. It helped her gain a full recovery, while preserving the rest of her hearing.
Having beaten the MDR strain of T.B. and the treatment side effects, von Delft made a tough decision. She gave up her dream of being a surgeon, and launched T.B. Proof, a nonprofit that pushes for new treatments and helps patients to access the existing drugs.
We need a very good vaccine. we need new drugs. And we need better diagnostics. But it is possible if we have the political will.
When she paid a visit to Sifumba's medical school, the younger woman was moved to join the fight.
People shouldn't be lucky to survive T.B.
Dalene was sharing her story, and I couldn't relate to her life or anything like that, but I could relate to the side effects that she had had. I could relate when Dalene spoke about rejection. I could relate when she spoke about stigma.
In June of 2018, the South African government officially replaced the injectables with bedaquiline. Sifumba rejoiced.
I felt like, for the first time, they were listening to our cry.
After completing treatment, she went on to finish medical school.
I'm that one intern who's like, "Oh, you have got MDR? Do you know I had MDR?"
And they're like, "What?"
I was like, "Yes, but, you know, I know it's difficult, but you're going to make it through."
Despite the severe side effects, both Zolelwa Sifumba and Dalene von Delft survived the grueling treatment. For future MDR patients, better options are finally more available.
Bedaquiline, which is approved by the U.S. FDA, and a second drug, with approval by European regulators, are both now in wider use. And just this month, clinical trials on a third drug were promising enough that the FDA put it under priority review.
For the "PBS NewsHour," I'm Hari Sreenivasan.
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