Bone TB rare but treatable when caught early
Tuberculosis is one of the most dangerous diseases in Kenya. It is highly contagious and had a death rate of 37 cases per 100,000 people as of 2019.
TB is an airborne disease caused by bacteria in the lung.
Bone TB is however different. It occurs when the bacteria spread through the blood to the lymph node, bones, spine or joints.
Experts say a person can survive with it without infecting others.
Bridan Ochieng lived with bone TB for two years without knowing what he was suffering from because his mother did not have the funds to take him to hospital.
His mother Roseline Akoth is single and has two other children.
She says Bridan was staying with his grandmother in the village when he started ailing in 2013. He was nine years old at the time, and upon going to hospital, he tested HIV-positive.
He was infected when he was an infant but was not put on medication because his mother did not know he had contracted HIV.
“I went home and took him to be put on drugs, he regained his health and went back to school,” Akoth says.
In 2018, Bridan started ailing again. He was diagnosed with TB and started treatment immediately.
To Akoth's dismay, her son fell ill again after finishing his six months of TB treatment.
“My son was put on TB drugs for six months but his health continued to deteriorate. Every time he finished the dose, the same problem would re-occur. He was put on TB treatment four times, which is equivalent to two years,” she says.
Bridan developed a growth in his lymph nodes but all tests came back negative.
In 2020, Akoth's friend referred her to a paediatric and TB specialist. At this point, Bridan was unable to walk.
“After taking samples, I was told to go home but a few days later, the doctor called me and told me to rush my son to the hospital where he was diagnosed with bone TB which was at the worse stage,” she says.
Bridan was put on drugs in a different hospital, Kinondoni in Kwale county.
The treatment was however too expensive for Akoth. Fortunately, an organisation called Helping Hands came to her rescue and got her son hospitalised.
Image: AURA RUTH
INFECTION
Akoth says by the time she got help in October 2020, her son was mere skin and bones.
Research shows that the disease can be dormant in the lungs and spread without the patient knowing they have it.
When bone TB is advanced, a patient may develop dangerous symptoms such as neurological complications, paraplegia or paralysis, limb-shortening in children and bone deformities.
James Mochama, a TB and leprosy coordinator in Mvita subcounty, says one may have a TB infection but not TB disease.
“When you have TB disease it spreads in the lungs and when you breathe out or cough, you spread the droplets in the air,” he says.
Mochama says when someone with diseases such as HIV or diabetes inhales the droplets, they easily get infected because their immune system is compromised.
When TB gets in the lungs, it is called pulmonary TB. It is diagnosed by examining sputum.
TB can spread outside the lungs into the bones and at this point it becomes known as extrapulmonary TB. It can spread to all parts of the body apart from the nails, hair and teeth.
“When a child stays with the mother or any other person who has TB infection, the child will inhale the droplets which later lodge in the lungs. The immunity will try to fight and if it gets compromised, the child can develop TB even after two years,” Mochama says.
Staying with someone who is infected does not mean that one will also get infected immediately.
In Bridan's case, Mochama says he might have inhaled droplets with mycobacterium tuberculosis, the bacterium that causes TB, from an infected person or he was exposed to an environment where people were infected.
Image: AURA RUTH
SYMPTOMS
The signs of pulmonary TB include cough, night sweats, weight loss, fatigue and fever. For bone TB, there will be deformities, Mochama says.
A person with bone TB may experience severe back pain, swelling, stiffness and abscesses. They may or may not experience the normal symptoms.
Mochama says in Mombasa the current co-infection rate of TB/HIV is at about 20 to 30 per cent.
“Around 80 per cent of the TB patients we treat in Mombasa are HIV negative. These cases are all forms of TB but we also have bone TB cases,” he says.
According to national statistics, Mombasa has a high TB burden and is ranked at position three.
In a year, the region gets around 3,000 to 4,000 TB cases.
One reason given for the high number is the people love for gathering for all manner of occasion.
Drug dens, slums and congested matatus are also among the main spreaders of TB.
“As a county, we have been working with organisations that have been helping us to identify patients and put them on medication," Mochama says.
The organisations help in tracking patients and tracing treatment defaulters.
Community healthcare workers also work closely with doctors to trace patients. The main challenge however is tracing drug addicts as they do not stay in one den.
“In most cases you find that the government evacuates drug addicts from their usual areas, and when this happens, they move to another place and tracing them becomes a challenge because they do not have any means of communication,” Mochama says.
Mocha says they have been working closely with Reachout Centre Trust to trace drug addicts and ensure that they take their medication.
Reach out Centre Trust is an NGO that helps drug addicts get methadone, a synthetic opioid used to treat addicts, and access free health services.
“Recently we opened a health facility at Reachout offices where our drug addict patients can easily get access to their daily medication because that is the centre where they go to get their food. This has helped in reducing the defaulter rate percentage,” Mochama says.
Image: AURA RUTH
TREATMENT
Bone TB is more common in developing countries and among people living with HIV-Aids.
It can be treated when diagnosed early.
The disease can lead to painful side effects but the damage is usually reversible when treated early with the right regimen of medications.
Medications are the first line of defence for bone TB and the course of treatment can last up to 18 months.
Mochama says it takes six months to treat pulmonary TB: A patient will be put on RHZE (Rifampicin, Isoniazid, Ethambutol and Pyrazinamid) for two months and four months of RH (Rifampicin, Isoniazid).
For bone TB or extrapulmonary TB, treatment takes at least 12 months.
“In the first two months, we enrol the patient on RHZE and 10 months of RH so after this period, the patient starts getting better and if there is any deformity of backbone, it starts getting back into the normal shape," Mochama says.
However, some patients take more than 12 months, depending on their status, he says.
When someone skips two appointments, they have to start the treatment afresh.
HOPE
The Covid-19 pandemic brought most activities to a standstill.
Some health facilities offering TB treatment in Mombasa closed, driving up the percentage of defaulters.
“Many patients used to visit different clinics but they don’t find anyone, this led to the high percentage of defaulters but we have worked to ensure the patients come on treatment," Mochama says.
One of the symptoms of Covid-19 was coughing. Many people with coughs, therefore, shied away from hospital for fear they would be told to take a Covid-19 test.
“Last year the number of TB cases in Mombasa went down due to fear but this year we are picking up and at least those who had decided to stay at home are coming back to continue with their treatment and the TB clinics that had been closed down at subcounty level have been opened,” Mochama says.
The health department is working with community health workers and organisations to encourage people to go for TB treatment.
TB is curable as long as it is diagnosed early. TB treatment and diagnosis are free people should not be afraid of seeking medical attention, he says.
Bridan is now recovering.
Mohammed Kareem, co-founder and chairperson of Helping Hands, says when they met Bridan, no one imagined he could walk again.
“We saw Bridan's story on Facebook and went to his rescue. We are always there to ensure that the family has shelter, food and other basic needs but we cannot provide everything on our own. So if we have any individual, organisation, and even the government, who can help let them come out. This will be a great thing to this young boy who has high hopes of living,” he says.
Bridan's family is appealing to well-wishers to help him enrol in school again as he works towards getting back on his feet. BY THE STAR
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