Tuberculosis

Tuberculosis (TB) is an infectious disease caused by a germ known as mycobacterium tuberculosis. Up until about 50 years ago, there were no drugs to cure TB. Now, we have adequate facilities and means to diagnose, prevent and treat TB. Yet, we are still facing a worldwide epidemic of TB. Worse, we are seeing an emergence of a TB germ that is resistant to the drugs we use to treat the disease.

TB infections are spread by breathing in droplets containing the TB germs. When people who are infected cough or sneeze, they spray TB germs into the air. Other people get infected when they inhale these TB germs.

Not everybody who gets infected with the germ develops the disease. The body's immune system 'walls off' the TB germ, which can lie dormant in the body for years. TB disease develops in about 10% of those infected. If your immune system is weakened e.g. by AIDS or drugs the chance of getting TB will be higher.

Causes & risk factors

TB is an air-borne disease transmitted through respiratory droplets from a person with the disease.
The risk of developing active TB disease is higher in:

• Persons with prolonged close contacts with someone known to have untreated TB
• Persons with underlying medical conditions such as HIV disease and diabetes
• Persons who have a weakened immune system e.g. due to drugs or sickness
• Persons who have poor nutritional status
• Drug addicts

Signs & symptoms

The following features raise the suspicion of TB:

• Cough lasting longer than 3 weeks
• Coughing out blood
• Feeling tired all the time
• Fever and night sweats
• Loss of weight
• Chest pain

Complications

Infection with TB can cause permanent lung damage if not treated early. It can also spread to other parts of the body such as the bone, intestine, brain and central nervous system where it can lead to life-threatening complications. The most serious complication, however, is when TB infection recurs and the strains causing the disease are resistant to multiple anti-TB medications.

Screening & diagnosis

If you have a cough that persists longer than 3 weeks or any of the other symptoms, see your doctor right away. If you know of someone who has the same symptoms, encourage the person to go as well. Your doctor will ask you to go for a chest X-ray. Some of you may be referred to a specialist for further investigations.

Treatment

TB disease can be cured with anti-TB drugs. To be effective, the drugs must be taken exactly as prescribed. Treatment usually involves a combination of several different drugs. Because TB germs die very slowly, anti-TB drugs must be taken for 6 to 9 months. You must continue to take your medicine until all the germs are killed, even if the symptoms of disease go away and you start to feel better.

Incomplete TB treatment means that the TB germs in the body that survive continue to grow and multiply. But this time, the germs may develop resistance to the usual TB drugs. In such situations, a different set of drugs with more side effects must be taken for a longer period. The chance of cure is also considerably reduced. What's more, the next person e.g. a family member, who gets infected, will have the same drug-resistant germs.

The World Health Organisation has advocated DOT as the standard of care for TB patients. DOT stands for Directly Observed Treatment. It means having your TB treatment supervised, usually at the polyclinics. Trained nurses will observe you taking the correct dosage and combination of TB medications. The best way to cure TB and curb its spread is to receive your treatment under the Ministry of Health's DOT programme.

Prevention

TB is a preventable disease. People with TB should be treated before they develop active disease. Also, one of the ways to control the infection is to take careful precautions with people hospitalised with TB.

There are also measures you can take on your own to help protect yourself and others:

• Complete the full course of your TB medications.

TB bacteria have a chance to become resistant to most TB drugs if full course of TB treatment is stopped. The mutant TB strains become more deadly and difficult to treat.

• Go for regular testing.

Skin testing is advised annually for those people whose immune system is weakened due to HIV or for those who have a substantially increased risk of exposure to the disease such as healthcare workers.

• Lead a healthy lifestyle.

Keep your immune system healthy by adopting healthy eating habits, exercising regularly and having enough sleep

If you have active TB, you can help keep your family and friends from getting sick by:

• Staying at home all the time especially the first two to three weeks of treatment.
• Covering your mouth with a tissue when you cough or sneeze and wear a mask in the presence of other people during the first few weeks of treatment.
• Disposing properly the dirty tissue by sealing it in a bag and throwing it away.

This article was originally published in http://www.hpb.gov.sg

Infections: What You Need to Know

“I caught [the] flu while in Singapore two years ago which then managed to become a viral infection giving the symptoms of a heart attack,” wrote a forum member at ExperienceProject.com, sharing his experience of viral infection. “Despite several hospital visits, doctors found no sign of heart disease and eventually, despite having occasional BP readings of 240/130, dismissed my symptoms as ‘being nothing wrong'.”

“I discussed the continuing decline in my health with my GP and the possibilities of a viral infection,” the forum member continued. “His advice was that he could not treat a virus and blood pressure pills would control the spikes, which they did not. Faced with increasing weakness and chest pains usually randomly around the chest and at any time of the day or night, I turned to alternative treatment.”

According to an article by Christian Nordqvist at MedicalNewsToday.com, many of us develop a wide range of infections but fight them off rapidly. Some people however develop persistent, long-term chronic infections. The majority is due to viruses such as hepatitis or herpes. Chronic bacterial infections are more likely to affect patients with diabetes as well as those with weakened immune systems.

Among the most common causes of infections mentioned in the MedicalNewsToday.com article are viral, bacterial and fungal infections. The following information is an adapted excerpt from the article.

Viral infections

Viruses are tiny organisms, much smaller than bacteria or fungi. The virus invades its host or the person with the virus and attaches to a cell, entering it and releasing genetic material (DNA or RNA). This genetic material helps the virus multiply and takes over control of the cell, making it replicate the virus. A cell that has this genetic material inserted into it cannot function properly and soon dies. When it does, it releases new viruses which infect new cells.

A person can get infected by:

• Inhaling the virus (breathing it in)
• Being bitten by infected insects or parasites
• Through sexual contact

Respiratory infections of the upper airways, nose and throat are the most common forms of viral infections. Some antiviral medications may help by either undermining the virus' ability to reproduce or by boosting the patient's immune system.

Bacterial infections

Bacteria are tiny single-cell microorganisms belonging to a group all by themselves, usually a few micrometers in length that normally exist together in millions. A gram of soil typically contains about 40 million bacterial cells. A milliliter of fresh water usually holds about one million bacterial cells.

Bacteria can live in virtually any kind of environment, from extremely hot to cold, some even in radioactive waste. A number of bacteria live in our bodies, on our skin, airway, mouth, digestive and urinary tracts—most of the time without causing any harm to the host.

A relatively small number of bacteria cause diseases in humans. Some of the most deadly diseases and devastating epidemics in human history have been caused by bacteria, including:

• Cholera
• Diphtheria
• Dysentery
• Plague
• Pneumonia
• Tuberculosis
• Typhoid
• Typhus

Bacterial infections typically show up with localized redness and heat, inflammation (swelling) and pain. Even with a throat infection, a bacterial infection will usually have more severe pain on one side of the throat. If there is pain in just one ear, it is likely to be a bacterial infection.

Fungal Infections

Fungal infection or mycosis is caused by the presence of parasite fungi in or on a part of the body. Some fungi reproduce through very small airborne spores which people either inhale or pick up on their skin.

Patients on long-term strong antibiotics are at higher-than-normal risk of developing a fungal infection. Strong antibiotics can eventually reduce the population of good bacteria which help maintain the balance of microorganisms in the intestines, mouth, vagina and other parts of the body. If enough of these good bacteria are destroyed, the fungi have an opportunity to grow and cause health problems for the host.

Patients with weakened immune systems, such as those with HIV/AIDS and individuals receiving chemotherapy have a higher risk of developing a fungal infection. Diabetes patients, especially those who do not have good disease control are also more susceptible.

Useful Information on Treatments for Infection (by NetDoctor.co.uk)

• Treatments for Viral Infections
• Treatments for Bacterial Infections
• Treatments for Fungal Infections

What You Need to Know about Infectious Disease

by The National Academies

For professional help with infections, please consult a family doctor or GP.

ENT: Hearing Imbalances

“I started out with ringing in my left ear,” said Debbie, sharing her experience of Meniere’s disease at Menieres-Disease.ca. “I went to three doctors when I developed the ringing because it was so loud that it interfered with my daily living. I even had a hard time sleeping at night.”

“The doctor told me that I had an inner ear infection and gave some antibiotics along with … [medicine] for the nausea and sent me home,” Debbie continued. “I noticed that my ear felt like someone had filled it full of water.”

What is Ménière’s Disease?

Ménière’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. This is according to an article at the website of National Institute on Deafness and other Communication Disorders (NIDCD). Ménière’s disease usually affects only one ear and can develop at any age, but it is more likely to happen to adults between 40 and 60 years.

Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some people with Ménière’s disease have vertigo so extreme that they lose their balance and fall, according to the article at NIDCD.

Cause and Diagnosis

The cause of Ménière’s disease is unknown, but predisposing factors include ear infection, allergy, head injury and positive family history. This is according to an article on inner ear fluid imbalance by Loyola Medicine at Stritch.luc.edu. An inner ear fluid imbalance is diagnosed by performing a history, physical examination, and hearing test. Sometimes other tests may also be necessary, such as auditory brainstem response (ABR) test, balance test, or a magnetic resonance imaging (MRI) scan.

Treatment

Ménière’s disease does not have a cure yet, but the doctor may recommend certain treatments to help patients cope with the condition. Some of the treatments mentioned in the NIDCD article include:

Medications. Prescribed drugs can help relieve dizziness and shorten the attack.

Salt restriction. Limiting dietary salt and taking water pills can help some people control dizziness by reducing the amount of fluid the body retains and lowering fluid volume and pressure in the inner ear.

Other dietary and behavioral changes. Some people claim that caffeine, chocolate, and alcohol make their symptoms worse. Avoid or limit such foods and drinks in the diet. Not smoking may also help lessen the symptoms.

Cognitive therapy. Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find cognitive therapy helps them cope better with the unexpected nature of attacks and reduces anxiety about future attacks.

Injections. Injecting antibiotic into the middle ear helps control vertigo but significantly raises the risk of hearing loss because it can damage the microscopic hair cells in the inner ear that help us hear.

Surgery. Surgery may be recommended when all other treatments have failed to relieve dizziness.

Alternative medicine. Although scientists have studied the use of some alternative medical therapies in Ménière’s disease treatment, there is no evidence to show the effectiveness of therapies such as acupuncture or acupressure, or herbal supplements such as gingko biloba, or ginger root. If using alternative therapies, patients are advised to inform the doctor as such therapies may sometimes impact the effectiveness or safety of conventional medicines.

Ménière's Disease: What Is It & How Is It Treated?

by The Dr Bob Show

For professional help with ear imbalance or Ménière’s disease, please consult a doctor or an otolaryngologist.