How to identify the symptoms of and airborne epidemic
Imagine. Joe is a 45-year old welder whose experience has earned him the right to train and mentor
newcomers on the job. He has a wife, two children and a house in a well-known township in
Johannesburg. Joe regards himself as happy and successful.
It was a few months after he visited his elderly parents in Limpopo, that he started to notice a
persistent cough followed by breathing difficulties. Since he smoked about fifteen cigarettes a day,
Joe decided to reduce this habit as the connection with his breathing difficulties seemed clear to
him. Although he had cut down his cigarette consumption to less than five a day, his symptoms
persisted. In fact, he started to notice that he was feeling increasingly tired throughout the day
and felt feverish and sweaty at night. He could only conclude that the workload and training
responsibility has been much greater lately and that his night sweats and fatigue were only natural
for a hard-working man like himself.
The annual wellness day presented the usual test opportunities, except this time the nurse started
asking him questions that sounded all too familiar:
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"Have you been coughing for more than three weeks? |
| ∙ |
Any night sweats or fever? |
| ∙ |
Are you feeling unusually tired? |
| ∙ |
Any shortness of breath or chest pain? |
| ∙ |
How about appetite - do you find that you do
not really feel like eating? |
| ∙ |
Have you lost weight without intending to? |
| ∙ |
Have you noticed any blood in
your sputum?" |
Joe's ever-widening eyes indicated his astonishment that this nurse could so accurately describe his
symptoms. Joe was immediately referred for a sputum test, which confirmed the nurse's suspicion.
During his visitation to his parents in Limpopo, Joe had travelled in an overcrowded taxi and sat next
to a woman who was constantly coughing. The windows were closed since most of the journey took
place during the night. Joe tried to ignore his coughing companion, but without his knowledge, her
coughing gave flight to airborne TB bacteria (Mycobacterium Tuberculosis). As he breathed deeply
during an attempt to sleep, the TB entered his airway and infected his already compromised lungs.
Joe had pulmonary tuberculosis.
TB is a notifiable disease, meaning that all cases are registered and treatment outcomes monitored
at a government level. Joe immediately initiated a six month course of medication. He started to
feel much better after a week of carefully following the doctor's instructions. All his family members
were also tested for possible infection. Joe's wife also tested positive for TB and started treatment
shortly after Joe. They were both booked off work for the first two weeks in order reduce the
chances of infecting co-workers. Joe returned to work feeling a new sense of motivation and energy.
His appetite started to improve and he stopped coughing and sweating at night.
Joe started to learn how he could avoid re-infection by avoiding people who cough or sneeze around
him. He learnt to wash his hands more regularly and to consider others when coughing and sneezing
by spitting into a tissue and discarding it safely. He has used his experience to teach his colleagues
about the symptoms of TB. He also learnt that if he misused or mismanaged his treatment, he could
have put himself and his family at risk of becoming infected with multi-drug resistant TB. This is a
serious strain of TB that cannot be treated with the basic first line of medication. Joe has helped
many of his colleagues to receive treatment timeously by identifying the symptoms he grew so acquainted with himself. In this manner, he played a meaningful role in reducing the chances of
others being infected. |
