Who Can Get It?

Anyone can get infected with tuberculosis but children, elderly and those who have lowered immune defenses have a higher risk of acquiring it. The bacteria are spread via droplet which means that the bacteria can be suspended in the air after an infected person sneezes. Close contact with infected persons such as talking and kissing can also transmit the infection. Fomites like a handkerchief used by an infected person can also transfer the bacteria. Since TB is highly infective, most family members who live in the same house with an infected patient will also most likely acquire TB unless proper preventive measures are taken. Health workers like doctors and nurses are also at risk for acquiring tuberculosis infection because constant exposure to patients in hospitals and health centers.

What Are The Symptoms?

The most common symptom of tuberculosis is chronic cough. Cough becomes chronic when it lasts more than 3 weeks. Cough can also be associated with sputum or phlegm, which sometimes can be blood-tinged. On and off fevers especially during the afternoon, night sweats and unexplainable significant weight loss are also common manifestations of TB infection.

How Is It Diagnosed?

Diagnosis of tuberculosis can be done using various imaging and laboratory tests. Usually a chest radiograph is requested to visualize tubercles in the lungs. However, it is possible that patients with active TB will turn up with a negative chest radiograph. A negative chest radiograph despite clinical symptoms of TB does not eliminate the suspicion of TB. A sputum smear or Acid Fast Bacilli (AFB) smear can also be done to detect the bacteria in the sputum. It is a non-invasive test wherein patients are made to cough up sputum which is then visualized under a microscope. It is a good test but like the chest radiograph, negative results do not rule out tuberculosis especially if the patient presents with symptoms. Another disadvantage of the AFB smear is that it is hard to perform on children and patients who are unable to cough out sputum. The most definitive diagnostic test for TB is the sputum culture however, the results of this test only come out after 4 weeks which may delay necessary treatment. Lung biopsy can also be done to identify the infection itself but this is a invasive procedure and is almost never used.

How Is It Treated?

Patients diagnosed with tuberculosis have to undergo at least 6 months of daily medications. It is usually a combination of 4 drugs: Isonizaid, Rifampicin, Pyrazinamide and Ethambutol. Patients with multi-drug resistant tuberculosis, which means that they do not respond to these 4 medications, will need an additional drug Streptomycin. Strict adherence to daily medications is a must to successfully treat TB which is why doctors usually require the patient to have a treatment partner to supervise daily intake of medications. This treatment partner can be a family member or a health worker working for DOTS. DOTS or Directly Observed Treatment Short Course is a program recommended by the World Health Organization to facilitate treatment of patients infected with tuberculosis.

How Can It Be Prevented?

In developing countries and countries where tuberculosis burden is high, children are usually required to receive a BCG vaccine which can prevent TB infection. Preventing transmission of TB is primarily the responsibility of the patient. A patient who is diagnosed with tuberculosis and who is receiving quadruple medications for less than 2 weeks  is still infective. Precautions such as wearing face masks should be taken. Family members or people in close contact with these patients should also be screened for tuberculosis.

What causes Legionnaires’ Disease?
After the initial outbreak, researchers found a previously unrecognized bacterium in tissue samples taken from the victims’ lungs. When the researchers studied blood samples kept from earlier outbreaks of pneumonia-like illnesses, they found that this same bacterium was responsible. In nature, this bacterium lives in lakes and streams,but it was found to be growing in the convention hotel’s central air conditioning plant, and had spread through the hotel’s air conditioning vents and plumbing. In other outbreaks, colonies of the bacteria were found in air conditioning systems and older water systems serving hotels, hospitals and other public places.

The legionella pneumophila bacterium is the primary cause of legionellosis in humans.

How is Legionnaires’ disease controlled?
Although methods of sterilizing heating and ventilating systems which harbour the bacterium have been introduced in Australia, outbreaks of Legionnaires’ disease continue to occur.

In Australia, government bodies which monitor health and safety in industry, have issued comprehensive advice about the control of Legionnaires’ disease in places of work, as well as public venues. They can shut down such places immediately and enforce steps to make heating and ventilating systems safe. They can also prosecute the owners of such places, if they are endangering employees or customers by having poorly maintained systems.

How is Legionnaires’ disease diagnosed and treated?
Blood and sputum tests are carried out to detect the bacterium. A  standard antibiotic, erythomycin, will kill these organisms and in most cases will result in a cure.

What can I do myself?
The disease does not appear to spread directly from person to person, but smoking, the heavy consumption of alcohol, and reduced immune system function all appear to increase the risk of contracting the condition.

If you suddenly suffer severe, flu-like symptoms, particularly if you have recently been at a hotel, exhibition or conference centre, you might suspect Legionnaires’ disease. This is a serious condition that should not rely on selfhelp. Although aspirin, fluids and bed rest are  helpful, you must have prompt medical treatment to prevent death from irreversible lung damage – a possible complication.

When should I see my doctor?
You should see your doctor immediately if you have any of the symptoms described overleaf. You may be suffering from another illness, but you may also be experiencing Legionnaires’ disease.

If you feel too ill to reach your doctor, ask a family member or friend to make you to be hospital emergency department. Flu and pneumonia, whatever their causes, become harder to fight off as we get older. For people with chronic diseases, such as diabetes, emphysema, or heart disease, they can be life-threatening.

What will the doctor do?
Your doctor will examine you closely, paying particular attention to your heart and lungs. Samples of suptum and blood will be taken for laboratory analysis. Chest x-rays will be taken, and if the problem is Legionnaires’ disease or any other pneumonia, they will show shadowing over the lungs. Tests of blood and sputum normally provide a definitive diagnosis.

The antibiotic erythromycin, which may be combined with other antibiotics in severe cases, should quickly eradicate the infection. Full recovery can be slow, and you may feel unwell for a month or two longer.

The course of Legionnaires’ disease
The flu-like symptoms appear rapidly. Coughing produces large amounts of phlegm. As the disease progresses, breathing becomes increasingly laboured. There may be confusion, disorientation and mental changes. If untreated, Legionnaires’ disease proves fatal in about 10% of cases. Prompt treatment with antibiotics reduces the danger, and most victims recover completely. Recovery may take months, especially for smokers and older people.

Is Legionnaires’ disease dangerous?
Legionnaires’ disease can be fatal within a few days, if untreated. Older people,heavy smokers and those with any chronic illness are particularly at risk; but healthy people will have a greater chance of recovering from the disease.

Symptoms of Legionellosis

• Flu-like upper respiratory infection, with fever, aches headache and pains.
• Coughing and slight or heavy phlegm production.
• Laboured or painful breathing.
• Diarrhoea, nausea and vomiting.
• Confusion, disorientation, and other mental changes.

What can I do to avoid Legionnaires’ disease?
If you work in an ageing building with central air conditioning, make sure that it is inspected regularly and that modern antiseptic systems are installed to prevent the air conditioning ducts from harbouring the Leigonnaires’ disease organism. Do not smoke, and try to avoid crowded, smoke-filled rooms if at all possible.

Here is the latest list of deaths, confirmed and suspected cases of the pig flu:

Australia (2000+, no longer scanning for H1N1 for mild symptoms)
Austria (confirmed 1, suspected 17)
Brazil (deaths 1, confirmed 977, suspected 2973) – last updated 11 July 2009.
Bolivia (suspected 1)
Canada (confirmed 19)
Chile (suspected 24)
Colombia (suspected 10)
Costa Rica (suspected 2)
Croatia (suspected 1)
Denmark (suspected 11)
El Salvador (suspected 2)
Finland (suspected 1)
France (suspected 30)
Germany (confirmed 4, suspected 17)
Guatemala (suspected 3)
Israel (2 confirmed, suspected 2)
Mexico (deaths 176, confirmed 32, suspected 2498)
New Zealand (15 confirmed, suspected 104)
Norway (suspected 1)
Peru (suspected 1)
Spain (10 confirmed, suspected 53)
South Korea – (suspected 17)
Switzerland (suspected 25)
Thailand (deaths 14, confirmed 3071) – last updated 11 July 2009
United Kingdom (5 confirmed,  suspected 96)
USA – (deaths 211, confirmed & suspected 37,246) – last updated 11 July 2009

WHO claims H1N1 has infected 94,512 worldwide and causing 429 deaths. – last updated 11 July 2009

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