If someone has severe breathing difficulty, haemoptysis (coughing blood), confusion, or collapse — call 10177 or go to the nearest emergency room immediately.
Most TB is managed as an outpatient condition. Some TB presentations and complications are medical emergencies requiring hospital-level care.
When TB Becomes an Emergency
Severe Haemoptysis (Coughing Up Blood)
TB erodes lung tissue and blood vessels. Mild haemoptysis (blood-streaked sputum) is common in active pulmonary TB and is not immediately life-threatening. Severe haemoptysis — large volumes of fresh blood — is a life-threatening emergency.
Action: Call 10177 immediately. The patient should be positioned on their side (affected lung down if known) to protect the airway. Do not give anything by mouth. Emergency intervention (bronchial artery embolisation, bronchoscopy) may be required.
Severe haemoptysis in TB is PMB-covered as a respiratory/haemorrhagic emergency.
TB Meningitis
TB can infect the meninges (lining of the brain and spinal cord), causing TB meningitis — one of the most serious forms of extrapulmonary TB with significant mortality and neurological sequelae.
Symptoms: Severe persistent headache, fever, neck stiffness (unable to flex the neck), photophobia (light sensitivity), confusion, seizures, vomiting.
Action: Call 10177 or go to the ER immediately. TB meningitis requires urgent lumbar puncture (CSF analysis) and same-day initiation of anti-TB treatment including corticosteroids. Delay worsens outcomes dramatically.
TB meningitis is a PMB emergency — all treatment is covered.
Pericardial TB (TB Pericarditis)
TB can infect the pericardium (sac surrounding the heart), causing pericardial effusion (fluid around the heart). Large effusions cause cardiac tamponade — a life-threatening compression of the heart.
Symptoms: Progressive breathlessness, muffled heart sounds, raised jugular venous pressure, low blood pressure, feeling faint. Often develops gradually but can deteriorate suddenly.
Action: ER immediately. Cardiac tamponade = emergency pericardiocentesis (needle drainage of pericardial fluid). This is PMB-covered as a cardiac emergency.
Respiratory Failure (TB Pneumonia)
Extensive pulmonary TB causing bilateral pneumonia, or TB in an immunocompromised patient, can cause acute respiratory failure.
Symptoms: Severe breathlessness, inability to complete sentences, fast breathing (>25 breaths/minute), blue lips or fingertips, confusion.
Action: Call 10177 immediately. ICU admission and ventilatory support may be required. PMB-covered as a respiratory emergency.
Spinal TB (Pott's Disease) with Neurological Compromise
TB of the spine (Pott's disease) affects the vertebral bodies. Progressive vertebral destruction can cause spinal instability and cord compression.
Emergency symptoms: Sudden worsening of back pain + leg weakness or paralysis, bladder/bowel dysfunction. This is a neurosurgical emergency.
Action: 10177 / ER immediately. Emergency MRI spine and urgent neurosurgical assessment. Spinal decompression surgery is PMB-covered.
Emergency Coverage Summary
| Situation | PMB Status | Action |
|---|---|---|
| Severe haemoptysis (large-volume blood) | Yes — emergency PMB | 10177 immediately |
| TB meningitis (headache, neck stiffness, confusion) | Yes — emergency PMB | 10177 / ER immediately |
| Cardiac tamponade from pericardial TB | Yes — PMB (cardiac emergency) | 10177 / ER immediately |
| Respiratory failure from extensive TB | Yes — PMB (respiratory emergency) | 10177 immediately |
| Spinal TB with neurological compromise | Yes — PMB (spinal emergency) | 10177 / ER immediately |
| Hepatotoxicity from TB drugs (jaundice, vomiting) | Yes — PMB (drug reaction management) | Urgent GP/ER; stop TB meds |
Drug-Induced Liver Injury — Urgent Clinical Warning
TB medication (particularly pyrazinamide and isoniazid) can cause drug-induced liver injury (DILI). In rare cases, this progresses to acute liver failure.
Symptoms warranting urgent medical review: - Jaundice (yellowing of skin/eyes) - Dark urine (tea-coloured) - Right upper quadrant pain or tenderness - Nausea and vomiting unrelated to starting medication - Extreme fatigue
Action: Stop all TB medication immediately and go to your GP or ER same day. Do not attempt to continue treatment through jaundice. Your LFTs must be checked urgently, and your TB treatment will need to be modified. This is a PMB complication event.
Do not restart TB medication without medical guidance after a DILI episode. Rechallenge requires supervised, sequential drug reintroduction under specialist supervision.
Occupational TB — Healthcare Workers and Contacts
Healthcare workers with TB are entitled to: - COIDA (Compensation for Occupational Injuries and Diseases Act) compensation if TB was acquired occupationally - Employer-funded occupational health assessment - Medical aid covers treatment as a PMB regardless of occupational origin
Close contacts of newly diagnosed TB cases should undergo: - TB screening (symptom screen + chest X-ray) - Isoniazid preventive therapy (IPT) if LTBI suspected (positive TST/IGRA with no active disease) - IPT is covered under the PMB
If Your Scheme Refuses to Fund MDR-TB Medication
If your scheme refuses to fund MDR-TB drugs (Bedaquiline, Pretomanid, Linezolid) citing cost or non-formulary status:
- MDR-TB treatment is a PMB obligation — drug resistance does not remove the PMB status.
- Have your pulmonologist or TB specialist write a formal clinical motivation citing the BPaLM regimen as per WHO/NTCP guidelines.
- Escalate to the scheme's medical director — not the call centre.
- Alternative: state MDR-TB units provide BPaL/BPaLM free of charge. For most patients, state MDR-TB units have equivalent expertise.
- Council for Medical Schemes: 0861 123 267 — for refusal to fund PMB TB treatment.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) ER24 (private ambulance): 084 124 Netcare 911 (private ambulance): 082 911 TB Hotline (NDoH): 0800 210 210 CANSA helpline (lung cancer differential): 0800 22 6622 Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →