You’re more likely to get tuberculosis if…

Dear doc,

What causes the malady tuberculosis?

Dear reader,

Tuberculosis is an infectious disease that is caused by bacteria known as Myocobacterium tuberculosis. The disease usually affects the lungs, but it can affect any organ in the body, including the heart and the skin. The bacteria spread when an infected person produces contaminated droplets through cough, sneezing, or singing, and another person inhales these infectious droplets. This means that TB can easily spread in crowded and poorly ventilated surroundings. TB is a notifiable disease, with monthly reporting, because it is a public health concern. This is because TB can be easily spread as it is airborne, and at the same time, the illness can have serious consequences.

For most people who are exposed to the TB bacteria, the immune system is able to destroy them. If a few of the bacteria survive, the immune system may form a protective covering around them, preventing them from spreading to the rest of the lungs and the rest of the body. This is called Latent TB. There are no symptoms with latent TB since there is no active disease. However, skin and blood tests that check for immune response to TB may turn positive.

When the immune system cannot control the infection, active TB disease develops. The symptoms depend on which area of the body is affected. The most common symptoms include fever, chills, drenching night sweats, weight loss, fatigue, lack of appetite, cough, blood in sputum and chest pain and/or pain when breathing. In children, there may be weight loss, a fever that does not subside, excessive irritation, reduced activity and poor feeding. Other symptoms depend on the affected organs.

There is a higher risk of acquiring TB in crowded, poorly ventilated places, or where there is prolonged close contact with an infected person. Having a weak immune system also increases the risk of developing active TB disease. This could be due to HIV infection; diabetes; alcoholism; smoking; being malnourished; being older in age; having cancer or as a consequence of cancer treatment; having severe kidney disease, or as a result of medication that affects the immune system.

TB is diagnosed through tests done on sputum, blood or urine and tests that are specific for the affected organs. TB is treatable, with antibiotics that are taken for six months (except for TB infection in the brain or bone, which is treated for a year). In case someone does not take the medication as advised, they can develop drug resistant TB, which tends to be more severe and requires a longer treatment duration of up to two years.

TB can be prevented by getting the BCG vaccine, which in Kenya, is given soon after birth. TB can also be prevented by observing cough etiquette and hand hygiene; by ensuring adequate ventilation; and by avoiding overcrowding. There is medication to prevent active TB disease for those at high risk such as people living with HIV; health care workers; those in prison; and those in close contact with someone with active pulmonary TB. In addition, for the first few weeks after starting treatment, those with TB lung disease are advised to isolate, wear a mask, observe cough etiquette and hand washing to avoid spread of the disease.

My newborn baby who is six weeks old keeps having hiccups. It looks so uncomfortable. What could be causing them?

Melvin

Dear Melvin,

Congratulations on the newborn!

Hiccups are quite common in newborn babies and they even happen while the baby is still in the uterus. Most of the time the hiccups do not cause discomfort to babies and they resolve on their own after a few minutes.

Hiccups happen as a reflex when the diaphragm contracts suddenly, followed by quick opening and closing of the vocal cords, which produces a sound. They are a reflex, which means that babies and adults have no control over them.

Most of the time hiccups have no apparent cause. Sometimes they can happen during feeds because of overfeeding, feeding too quickly or swallowing a lot of air while feeding. In this case, the over-expansion of the stomach then triggers contraction or spasms of the diaphragms, which causes hiccups.

If the hiccups happen too frequently or seem to be causing the baby distress, then the baby may be having gastro-esophageal reflux, where stomach contents move back up into the esophagus, causing irritation and contraction of the diaphragm. In addition to hiccups, if the baby is more irritable than usual, or spits up more than usual, or looks very uncomfortable or arch their back excessively during or after feeds, then it is likely that they have gastro-esophageal reflux. In this case it is advisable for the baby to be reviewed by a doctor.

Measures to reduce hiccups include: a) Ensuring that the baby latches well when breastfeeding to avoid swallowing a lot of air.

b) Feeding the baby when s/he is calm. This means that you need to anticipate when the baby will get hungry and begin to feed them before the crying/fussing begins.

c) Feed the baby slowly.

d) Burp the baby during feeding.

e) Hold the baby upright for half an hour after feeding.

f) Provide frequent, smaller feeds rather than overfeed.

Is there medication to prevent pregnancy after unprotected sex?

Wallace

Dear Wallace

There is emergency contraception, which can prevent pregnancy if used within 120 hours of having unprotected intercourse. Emergency contraception can also be used if there are concerns that the current contraceptive method in use has failed or will fail. It is also prescribed following rape or forced sexual intercourse. There are several forms of emergency contraception: pills that are taken just once and some that are taken at two different times, or an intrauterine device inserted, which can then remain for several years. In the event that the emergency pill has to be taken on multiple occasions, then it is advisable to get a reliable long term contraceptive to avoid contraceptive failure and side effects from frequent use of the emergency pill.

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