Vigil Continues for Nelson Mandela

Former South African President Nelson Mandela remains in critical condition at the Mediclinic Heart Hospital in Pretoria, South Africa. The 94-year-old has been hospitalized for a recurring lung infection. It has been reported that Mandela is on life support.

South Africans have gathered outside the hospital, lighting candles and posting messages of support. Many sing songs of praise. Current South African President Jacob Zuma has cancelled his visit to Mozambique on Thursday because of Mandela’s ill health.

Mandela is revered by most of the country’s 53 million people as the key architect of the movement that brought an end to apartheid. Mandela spent 27 years in prison for plotting against the white majority government. He served one five year term as South African’s first black president, stepping down in 1999.

During his long imprisonment, Mandela contracted tuberculosis, a lung infection that can lead to chronic lung problems such a infections.

What is Tuberculosis?

Tuberculosis infection has been around for a long time. Evidence of tubercular decay has been found in the spines of Egyptian mummies thousands of years old, and TB was common both in ancient Greece and Imperial Rome.

Tuberculosis is caused by the infectious agent known as Mycobacterium tuberculosis (Mtb). This rod-shaped bacterium, also called Koch’s bacillus, was discovered by Dr. Robert Koch in 1882.

tb spreadWhen a person breathes in Mtb-contaminated air, the inhaled TB bacteria reach the lungs. This causes a tuberculosis infection.

However, not everyone infected with TB bacteria becomes sick. The bacteria can remain dormant (asleep) for years and not cause any TB disease. This is called latent TB infection. People who have latent TB infection do not get sick and do not spread the bacteria to others. But, some people with latent TB infection eventually do get TB disease.

Tuberculosis_symptoms.svgEarly symptoms of active TB can include:

  • weight loss
  • fever
  • night sweats
  • loss of appetite

Symptoms may be vague, however, and go unnoticed by the affected person. For some, the disease either goes into remission (halts) or becomes chronic and more debilitating with cough, chest pain, and bloody sputum (saliva).

Symptoms of TB involving areas other than the lungs vary, depending upon the organ or area affected.

Between 2 to 8 weeks after being infected with tuberculosis, a person’s immune system responds to the TB germ by walling off infected cells. From then on the body maintains a standoff with the infection, sometimes for years.

Most people undergo complete healing of their initial infection, and the bacteria eventually die off. A positive TB skin test, and old scars on a chest X-ray, may provide the only evidence of the infection.

If, however, the body’s resistance is low because of aging, infections such as HIV, malnutrition, or other reasons, the bacteria may break out of hiding and cause active TB.


How is TuberculosisTreated?

With appropriate antibiotic treatment, TB can be cured in most people. Successful treatment of TB depends on close cooperation between patients and healthcare providers. Treatment usually involves taking several antibiotic drugs for at least 6 months and sometimes for as long as 12 months.

Antibiotic Resistance and the Importance of Finishing the TB Medicine

People who do not take all the required medicines can become sick again and spread TB to others. Additionally, when people do not take all the prescribed medicines or skip times when they are supposed to take them, the TB bacteria evolve to outwit the TB antibiotics. Soon those medicines no longer work against the disease. If this happens, the person now has drug-resistant TB. Additionally, some people with TB do not get better with treatment because their disease is caused by a strain of the TB bacterium that is already resistant to one or more of the standard TB drugs.

For more information, go to the Resounding Health Casebook on the topic.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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