Being a researcher who studies TB in the lab is one thing, having the bug in your lungs is quite another. Spotlight’s Elri Voigt spokes to two of a relatively small number of people who have experienced both.
In April, Constance Schreuder, a senior medical technologist at a large research group at the University of Cape Town, was called into the campus’ occupational health office. “I was thinking, did I do something wrong?” she recalls.
When she got there, the doctor immediately opened the window behind him before telling her she had tested positive for the very illness she has been studying at the South African Tuberculosis Vaccine Initiative (SATVI) for more than two decades.
Part of Schreuder’s job involves working with post-mortem samples and tissues, as well as clinical trial samples from different TB research sites.
“We always wear the correct PPE. So, we’re always safety first,” she says. “But I was actually exposed in the office where I sit… after all the years I’ve been working in the lab.”
Schreuder was confused by the diagnosis because she didn’t, and still does not, feel ill at all. She had been tested two months previously as a precaution after a PhD student in the lab had been diagnosed with TB and become very sick.
Her initial test results looked good. She had produced a sputum sample which was sent to the lab for molecular testing (using the GeneXpert platform). It came back negative. She had also had a chest X-ray, which showed no signs of TB in her lungs.
It was another test result that raised the alarm. Apart from the GeneXpert test, her sputum sample had been sent to be cultured. This involves putting it into a Mycobacteria Growth Indicator Tube (MGIT), and attempting to grow the bacteria if any is present. If TB bacteria has grown after around 50 days, then it means the TB bug was present in the sample.
In Schreuder’s case, the TB bacteria did grow, although the bacterial count was low, a result in keeping with her lack of symptoms.
Although she was sceptical of the result and wondered about a potential lab error, Schreuder’s thoughts immediately went to her close contacts – her 81-year-old mother, her pregnant daughter, and her son.
No one else from the office who had been tested showed any sign of TB disease, although Schreuder says that not everyone’s sputum sample had been cultured due to the cost of the test.
Only about one in 10 people who are exposed will become sick with TB. In most people, the immune system contains and eventually starves the bacterium to death. In others, however, the bug survives and eventually causes illness weeks, months, or even years later.
A silent form of TB
Schreuder probably has what is called asymptomatic TB – where the bug is active, but it is not, or not yet, resulting in symptoms. There are many unknowns about this state, how much it actually contributes to TB transmission and how best to test for and treat it.
While there is much uncertainty about the prevalence of asymptomatic TB, some rough numbers exist. South Africa’s first First National TV Prevalence Survey found that just more than half of the participants with TB confirmed through molecular testing had no symptoms.
Schreuder said she was under the impression that people had to show at least some symptoms if they were ill. She was given a sick note, told to go to a public clinic for treatment, and booked off for 14 days. People who are ill with TB generally become non-infectious after taking TB treatment for around two weeks.
South Africa’s TB Treatment Guidelines do not recommend different treatment courses based on whether or not someone has symptoms, meaning Schreuder has to take the full six-month course.
‘I thought it was something serious’
Schreuder’s experience is one side of the coin, the other side is a story from the same lab.
Tatenda Bvudzijena, an energetic young student, is doing his PhD at the SATVI lab because he wanted to learn from their world class research. He shares an office with several people at SATVI, including Schreuder. It was his TB diagnosis that had prompted the staff to get tested.
Bvudzijena describes himself as hard-working, so it was unusual when he started feeling too tired to complete lab work near the end of 2025. He was finishing up the second year of his PhD at the time. He tried taking some vitamin B, but it didn’t help. Then he started to develop some of the typical symptoms of TB, persistent cough and weight loss. The cough didn’t go away after he treated it with over-the-counter medicines.
“I had those coughing symptoms, then they disappeared, then came back again,” he says.
A private GP told him he might have asthma, but none of the medication he was prescribed – anti-inflammatories, cough syrup, antibiotics, and asthma pills – worked.
Meanwhile, he kept getting sicker.
“By that time, I had chest pains and was losing a lot of weight,” Bvudzijena says. “I just remember back then I used to wear size 32 jeans…then I was wearing size 28…I was less than 55kg, but I used to be 70kg.”
He was starting to panic because the pain in his chest felt sharp. “I thought it was something very serious,” he adds: “I thought maybe I had lung cancer, because I used to vape.”
Then, one morning in February, Bvudzijena went to see another private GP. This time he was immediately sent for a TB test and a chest X-ray. “Your X-ray is showing symptoms suggestive of TB,” the doctor told him two days later.
Bvudzijena was both scared and relieved. Relieved because TB can be cured and he did not have something incurable, but also scared because seeing his own chest X-rays, he realised he was quite sick.
Bvudzijena has to take the same six-months-course of treatment as Schreuder.
The treatment
In South Africa, “typical” or drug-susceptible pulmonary TB in adults is treated with a six-month treatment course – four drugs for two months and then two drugs for the next four months.
TB is mostly treated in the public healthcare sector, so even if someone has medical aid or access to private sector healthcare, they might still go to state facilities for treatment.
TB treatment and diagnosis is covered under the minimum prescribed benefits for medical aid members. According to the Council for Medical Schemes, members can get treatment through public sector clinics, but should be given the option of getting their treatment through the private sector. Whether they can get treatment in the private sector is likely to depend on whether they can find a doctor comfortable with treating TB and a pharmacy that stocks TB medicines.
Still showing no symptoms of TB when she started treatment, Schreuder says she has had some side effects. At first, it was only constipation and her urine turning orange, a side effect of rifampicin, one of the four antibiotics. But by the second month, she also started having muscle and joint pains as well as burning feet.
Schreuder will start on the less intensive four remaining months of the course soon, when the regimen drops from four down to two antibiotics. But she worries about what the drugs might be doing to her body.
With TB already taking its toll on Bvudzijena, he says he started treatment knowing he had to be serious about taking it as prescribed.
“I know I was very sick and based on the chest X-rays, this (TB disease) was intensive. So I absolutely had to take the meds,” he says.
His side effects have been relatively mild: a runny stomach and skin rash, and joint pain when he started the two-drug phase of treatment.
He says he started feeling better soon after starting treatment, got his appetite back, and his symptoms disappeared completely.
Two clinics, two different treatment experiences
Before they could start their treatments, Bvudzijena and Schreuder had to get access to the drugs, which was easier said than done.
Bvudzijena says when he got his chest X-ray, all he was told was he needed to go to Groote Schuur Hospital. So he went, only to find that because the hospital’s waiting rooms employ a triage system, he’d probably have to wait several hours.
He left and went to a doctor at a private hospital, where he was referred to a specialist there – who would have only been able to see him a week later. Desperate, he went to campus health, who put him in touch with a nurse at a nearby state clinic.
There, he says he was well taken care of, and given a little green card identifying him as a TB patient. This is his ticket to travelling through the clinic quickly and not having “to wait in a long queue wearing a mask”.
Schreuder, after being booked off, had Googled the nearest state clinic offering TB treatment. The next day, she drove to one nearby, arriving early.
“I got there at 6.30 because I wanted to just get it over with and start with the medication. They say if you take it for 14 days, you’re not infectious anymore,” she says.
At the clinic, she was taken to a separate room to wait by herself – as it turns out, for five hours. Eventually she was helped by a nurse, who filled out her paperwork and took another sputum sample.
Another hour later, she left with six packs of TB medication, enough for the first month of treatment. But she had to stop at a private pharmacy on the way home because the clinic was out of vitamin B6, which she was told to take to help with the potential side effect of “pins and needles in your hands and feet”.
Her frustrations with the system would mount. At a subsequent clinic visit, she found her phone number hadn’t been captured, meaning she hadn’t received the test results from her second sputum test. When she asked for her medicines to be dispensed to her ahead of time, as she was already at the clinic, she was told they were out of stock.
When she arrived for her next appointment at 12 noon on a Friday in May, she says the clinic was empty. She eventually found a nurse who told her she was only working until 12, that the rest of the staff had left for a party for someone who had resigned, and that Schreuder must return on Monday. A frustrated Schreuder says she didn’t accept this and eventually the nurse agreed to give her the meds.
“I said to her, ‘I work in this clinical trial lab where we want to find a cure for TB. But are we going to reach a TB-free world if it (the health system) works like this?’.”
What needs to change?
Both Bvudzijena and Schreuder say it needs to be easier for people with TB to start and collect TB treatment. They suggest private sector pharmacies could be a convenient alternative to public clinics. Bvudzijena adds that stable patients could also collect their medication from selected community pharmacies or other collection points closer to home, reducing unnecessary travel and long waiting times.
He also highlighted the need for better, clearer information for people who have just been diagnosed about where they need to go, what documents they might need, and how to start treatment.
“When you’ve just been told you have TB, you’re already worried,” he says. “The last thing you need is to be sent from pillar to post without knowing where to get help.” There needs to be better co-ordination between private healthcare providers and public clinics, he suggests.
He says the illness changed his perspective on the research with which he’s involved.
“What I realise now is that this research is about so much more than science. My work is focused on improving TB diagnosis so people can be diagnosed earlier, while many of my colleagues are working on better treatments and vaccines. After going through this myself, I know how much that work can mean to someone who’s sick. It’s really going to change people’s lives.”
For Schreuder, the experience has also been eye-opening but in a different way. She recounts some of the stories she heard while waiting at the clinic, a woman who arrived at 5.30 but hours later still hadn’t been helped because her file was missing; a man who was afraid he would lose his job if he waited any longer; patients waitiing outside on cold benches and concrete floors, some looking very ill.
Long waiting times is a common problem. “I can fight my own battles, but what about all of those who are too afraid to say something?” she asks.
See more from MedicalBrief archives:
Crucial advance in MDR-TB treatment from South African team – NEJM
Tackling the threat of asymptomatic TB in South Africa
Most TB patients don’t have persistent cough – global study
Digital X-rays increase TB detection in asymptomatic South Africans