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THE TREATMENT OF TUBERCULOSIS

Q: I need information on tuberculosis. My brother never smoked or drank in his life. He got tuberculosis.

He has been taking rifampic, ethambutal, pyrazinamide and isoniazid for the last six weeks. His fever is not going down. Every night he has a fever; he is losing weight and coughing, too.

His doctor says he is going to be all right, but it may take nine months or a year. -- S.B., Debary, Fla.

A: You must be very concerned about your brother. To watch him seemingly waste away without being able to help is both frightening and frustrating. Let me explain the disease and perhaps that will help.

Tuberculosis is a chronic bacterial infection of the lungs, characterized, as you noted, by tiredness, weight loss, fever and coughing up phlegm.

The disease is contracted by inhaling the live bacteria in the air exhaled from an infected person. If the inhaled bacteria can persist and multiply before the immune system can attack and destroy them, the infection sets in. So, to contract tuberculosis, your brother must have been exposed to the bacteria when his immune system was impaired.

It is not always easy to determine when and where an individual has been exposed to the infection. Tuberculin bacteria can lie dormant in the lungs for years. However, you're more likely to be exposed if you are in close contact with others that may be infected, such as in crowded urban areas or in institutions.

Most of the increase in tuberculosis in this country over the past 10 years has occurred in HIV-positive individuals, immigrants, minorities and prisoners. However, many other people also get TB.

Because the body walls off the TB bacteria as part of the defense against them, it is hard for antibiotics to reach the bacteria. That's one of the main reasons tuberculosis is a long-term disease that takes many months to cure. Hospitalization is no longer necessary in early stages of the infection unless the person is incapable of self-care or could expose others to the disease.

From what you have said, your brother is in the middle of one of four standard multidrug regimens for initial treatment of tuberculosis. Fortunately, almost all properly treated individuals with tuberculosis are cured and relapses are rare.

Your brother is fortunate to have your care and understanding. Because the main cause of therapy failure is not complying with the established treatment plan, be sure to encourage him to be patient and to continue taking his medication through this long and difficult period. He also may need encouragement to maintain a good diet.

Q: My fingernails have ridges (like a washboard). A friend says it is a medical condition. Is she correct? And what should I do? I am 70. -- E.T., Kansas City, Kan.

A: Your friend is partly correct; the ridges on your fingernails may be a "medical" condition.

In general, nail disorders are caused by hereditary factors, fungal or bacterial infection, allergies to irritants, physical injury or as a result of other diseases, most often skin-related.

The first thing I would need to know before providing advice is whether the problem is limited to one or two nails, or whether most or all nails are affected.

If limited to one or two nails, the causes are usually injury, irritants or infection. Injured nails tend to repair themselves as they grow. For other localized problems, proper cleaning and manicuring helps, as does wearing gloves when working with irritating materials. Antibiotic and antifungal lotions or creams can combat nail infection. Hereditary systemic nail problems are not usually correctable.

Washboard ridges usually occur on most of the nails at the same time and the ridges run front to back on each nail. The problem may be due to some other disorder that may show up under or around the affected nails.

If you feel your nails are unsightly and the condition detracts from your appearance, you may wish to discuss a treatment plan with a health-care professional, perhaps a dermatologist. This would be particularly important if the condition is relatively recent or you suspect a disorder other than an infection.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health care provider.

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