Written by By Rachel Long, CNN
Tuberculosis (TB) used to be treated with antibiotics, but today the disease is increasingly complicated with related health issues including leishmaniasis, HIV and hepatitis B and C.
These diseases often arise from a wide array of environmental factors, but this was not the case for “Charlie,” a man recently treated in China for TB.
“We’ve only learned about this recently,” says Lee Midgett, head of research and strategic partnerships at the Universities of Cape Town, Johannesburg and Durban, and the author of “Pathogenic Phoebe,” which looks at the epidemic of leishmaniasis in southern Africa.
In China, the man was given an injection to combat his TB, but it took a long time for his symptoms to appear. Because he didn’t have these symptoms until he became infected, he didn’t have any previous exposure.
What’s more, when he was finally diagnosed with TB in 2016, the drug he had been given that may have been responsible for his leishmaniasis treatment was long expired.
Had he received that drug, an experimental treatment called Akritins–which attempts to mitigate the impact of the parasite — would have been available to treat his leishmaniasis. In addition, his TB could have been prevented.
“He was rendered bedridden for over a year because there was nothing we could do for him. Although he was perfectly healthy, he had a bad TB and no access to any TB medicines and he had leishmaniasis … but he could not be treated with TB,” says Midgett.
Charlie, whose full name has not been published, was treated for 13 months at a Beijing hospital for tuberculosis and leishmaniasis until he got tired of being kept in.
“When he wanted to leave, he was taken away and left in an ambulance. To our horror, in a few hours he was convulsing and falling over. This was some 13 months after he was finally given TB treatment. He was in really bad shape,” says Midgett.
Charlie didn’t survive, and died in November 2017 of an acute viral lung infection related to leishmaniasis and during the treatment of TB.
Leishmaniasis is a chronic leishmaniasis infection carried by sand flies and small blood-sucking flies. In south Africa, it is one of the most common water-related disease, and is most widespread around the Kruger National Park.
Door opener for TB
When it comes to TB, leishmaniasis is often the trigger.
“This was a new thing. We don’t know what leishmaniasis is doing to the brain,” says Midgett.
Until recently, leishmaniasis was regarded as an inherited skin infection.
“TB is transmitted by inhaling airborne dust, so we assumed that the parasite infecting Charlie’s brain is an inherited disease, and that it is there before Charlie gets tuberculosis,” says Midgett.
Tuberculosis, in contrast, is spread through the air when bacteria breaks through the walls of the lungs, spreading into the bloodstream and infecting the immune system.
Midgett says that a high body count is a sign that active TB transmission is occurring, whether it occurs within the first hour of a patient’s exposure or years later, when they develop severe diarrhea and acute leishmaniasis.
When Charlie’s flu-like symptoms struck, he was rushed to the Beijing hospital where a necropsy revealed that he had contracted both leishmaniasis and tuberculosis.
Doctors have developed another treatment for leishmaniasis. This should be available by the end of the year, but has to be approved by an ethics committee in China, says Midgett.