Over the past seven years, the number of tuberculosis cases has been on the increase in Ireland
Q My brother has been unwell recently and had a bad cough. He was seen in the hospital and has been diagnosed with pulmonary tuberculosis. I thought this disease had been eradicated in this country.
Is my family at risk of contracting the disease from him? How long will he have to take his treatment for and are there any side effects to the treatment? Are there any long-term problems with having this disease?
ATuberculosis was never eradicated from Ireland and over the past seven years the number of cases has been increasing. This is of concern and needs to be addressed. A new problem has emerged in that there are now a lot of multiple drug-resistant cases of TB. These cases are especially difficult to treat with lots of side effects.
Yes, it is possible that others may have caught the disease from your brother and if this is the case then they must be treated. By the time a patient is diagnosed with tuberculosis, members of their families have a 50/50 chance of having caught the infection from them.
Most people who catch the infection never actually get the disease. The infection “goes to sleep” and doesn’t wake up, and this is called “latent” TB infection. There is a big difference between having tuberculosis disease and latent TB infection.
People with latent TB infection cannot transmit the infection to other people, but they are treated to prevent them from becoming ill. People with tuberculosis disease in their lungs, however, can transmit it to other people, and we find that with each case we see, about 12 other people have become infected. These other people are contacts, and they can be offered medication to keep them well.
The treatment for tuberculosis disease takes, at the very least, six months, but may take longer, and the medications do have some side effects. These are usually very manageable and include upsetting the liver. For that reason we advise patients to avoid taking alcohol and drugs that may affect the liver, such as paracetamol, for the duration of their therapy. In addition, one of the drugs may cause pins and needles in the fingers and toes, and to prevent this, vitamin B6 is given.
If the tuberculosis pneumonia that your brother suffers from has affected a significant amount of the lung, he may have long-term problems once the TB has been eradicated. This may manifest itself with a chronic cough productive of sputum because of damage to the tubes in the lungs. In rare cases, these can cause coughing up blood, and repeated chest infections. Fortunately, most patients do not endure long-term problems.
Q I am 45 years of age and have recently had a medical check-up. Everything seemed to be fine except for the fact that my cholesterol was a little high. What is cholesterol and why is it so important? How does it affect my heart?
ACholesterol is a fat, which is a normal part of any diet and normal levels are needed in many animals and in man.
High cholesterol levels, however, have been identified for over 50 years as likely to lead to a higher risk of heart attack, stroke and peripheral vascular disease (blockages in the legs).
It seems that when high levels of cholesterol have been present for many years, cells stuffed with fat become embedded in arteries in the heart and head.
Over time, this deposition of fat will lead to blockages in these arteries, which in turn leads to heart attacks and/or stroke. This type of build-up is one of the leading killers in the western world.
Teenagers in western society start to build up “fatty streaks” in their major blood vessels, which will later lead to real problems.
The real issue is that “normal” cholesterol levels in the western world are, in historical and evolutionary terms, very high.
The Bantu and Kalahari Bushmen (with whom we share the same genetic make up) have cholesterol levels about half of what we would consider to be normal, and they have no coronary disease.
It would appear that our western diet has led to very high levels of cholesterol from a very early age.
There is “bad” cholesterol which is called low-density lipoprotein (LDL) as well as good cholesterol, high-density lipoprotein (HDL). It is the balance between the two which is important.
Cholesterol is one of the real “treatable” factors to help decrease the incidence of coronary disease. Strict diet alone can be very successful in lowering your levels of cholesterol and the key issue is to minimise your intake of animal fats such as butter and to eat a moderate amount of red meat. Exercise is also very important.
In the past 15 years, effective medications have become available which markedly reduce cholesterol.
This has, in turn, been shown to reduce the risk of developing heart attacks and stroke. Not everyone with high cholesterol is offered these tablets, as the aim is to treat those at highest risk (family history, smokers, high blood pressure etc).
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin, with a contribution from Dr Ross Murphy, consultant cardiologist, and Prof Joe Keane,consultant respiratory physician, St James's Hospital, Dublin
- Please send your questions to healthsupplement@irishtimes.com
