Health: 'I still have no idea how I caught TB'

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As tuberculosis returns to affluent societies, even those vaccinated in childhood may be at risk of contracting the illness. Sarah Jewel reports.

Giles O'Bryen, a publisher, 38, went on holiday last Easter in Devon with his family before his wife gave birth to their third child. He came back home to London feeling rather more tired than he had expected after a week's break, and woke up with a blinding headache which got steadily worse. He also suffered terrible aches in his legs and lower back. His doctor said he had a slight urine infection and prescribed a course of antibiotics.

But despite taking antibiotics and "guzzling painkillers", Giles felt progressively ill. He had a very high temperature and felt delirious to the point where he didn't know if he was awake or asleep. He started having terrible dreams and kept waking drenched in sweat, exhausted and frightened.

He had one very vivid recurring nightmare. "I was slogging up a hill in a clapped-out seaside town and a really unpleasant spotty lout with a slavering dog at his side kept tracking me. Every time I thought he had gone, suddenly he would be there again and he kept saying things to me like, 'you'd better not move', and I'd say, 'why not?', and he'd say, 'because my dog's got you', and I'd look down and there was his dog with my knee clamped in its mouth. Eventually I hid in a little seaside shack but he kept bursting through the wall panels with a knife in his hand." Afterwards, Giles felt that this man was a personification of his disease.

His wife, Emma, became so worried she called the doctor out on a home visit. He took one look at Giles and decided to admit him to hospital immediately, where he was prodded and poked by a team of doctors who couldn't find anything wrong. Eleven hours later, they were about to discharge him when one of the doctors decided to give him an X-ray, and it was then that Giles was told there was "something odd" showing up on the X-ray and that there was a cavity in one of his lungs. He was eventually diagnosed as having tuberculosis and immediately moved to the isolation ward.

Giles was appalled. "I felt shocked and anxious at the thought of having TB and watched with horror as the nurses inserted a drip into my hand and started sluicing me through with antibiotics." He has no idea how he caught it, or from whom. But it can easily be picked up just from someone else sneezing.

Once a disease affecting all levels of society, TB was exiled to the poorer regions of the world following the discovery of antibiotics. Today, after decades of being on the decrease, TB is back in more affluent societies. The number of notified cases in England and Wales between 1987 and 1993 rose by 17.2 per cent and a similar pattern was observed in other European countries and the US.

Although the proportion of people catching tuberculosis from middle-class backgrounds is still small, the disease, which is caused by the bacterium of the same name being passed from person to person by airborne droplets, is no respecter of class or creed. Dr John Moore-Gillon, TB specialist at St Bartholomew's hospital and the Royal London hospital, says: "A Eurobond dealer earning a quarter of a million pounds can catch TB, and I have had a patient like that. But it is still more likely to be caught by people who are sleeping rough on the streets and who are undernourished."

Symptoms may include coughing (sometimes bringing up blood), chest pain and shortness of breath (although Giles had none of these), as well as fever and vomiting. Thanks to antibiotics, healthy patients like Giles will make a good recovery; but dangerous complications can still occur, such as fluid or air collecting between the lung and chest wall.

TB remains the most common infective cause of death among adults worldwide; the World Health Organisation has estimated that in 1992 one third of the world's population was infected with the disease. In 1993 WHO declared TB a "global health emergency", and in March this year introduced a new strategy for managing the drugs that are used to control TB.

Although Giles was vaccinated against TB when he was a child, the BCG does not give life-long immunity and is only expected to last about 15 years. As Professor Denis Mitchison, research professor in tuberculosis, says: "A vaccine provides 80 per cent protection in childhood against TB but by the time the child becomes an adult the BCG has very much less value." He says no studies have been done to show if a booster later in life improves protection.

Four powerful and bacterial drugs have to be taken for six months to cure TB and they can have nasty side-effects, ranging from orange-coloured urine to liver damage to psychosis. More commonly, patients suffer from slight nausea and lethargy. Giles stayed in hospital for a week and then returned home feeling better but very weak and slightly jaundiced by the drugs.

He tended to feel faint in the mornings and it was hard work getting through the daily line-up of pills: "There was a lot of munching at breakfast time." He had to give up drinking as even one glass of wine made him feel woozy and he also developed gout. "I said rather shamefacedly at the clinic one day, 'I'm not sure if I should mention this to you but I've been getting these pains in my knees', and was told, 'oh that will be gout, yes they can give you gout these pills'."

One of the major problems with TB is that the antibiotics have to be taken for a long time to prevent the risk of a relapse. "The medical profession is terrified of TB coming back and the only way they have of dealing with it is with these massive doses of antibiotics," says Giles. Widespread failure to complete the drug course has led to the emergence of potentially incurable multidrug-resistant TB.

At the clinic Giles attended the walls were lined with notices warning of the dangers of not taking the drugs. "You've got to complete the course, otherwise it is bad news all round, not just for the patient but for the whole community," he says. But it is impossible to force patients to complete the drug treatment. As Dr Moore-Gillon says: "It is a difficult situation because of the issue of personal freedom. We cannot compulsorily treat someone. In the US coercion is used in some some states to force people to take their tablets."

Giles's main worry on leaving hospital, however, was for his family. His wife, Emma, was due to give birth any day and they were told that if the baby was born within the first two weeks of Giles starting his course of antibiotics (when he was still infectious), the baby would need a BCG injection at birth. "It was a nightmare trying to find out who would actually give the injection ... no one wanted to take responsibility for making the decision to vaccinate a new-born baby or to administer the vaccination."

Luckily Emma did not go into labour until a few days after the crucial two-week period but they decided when the baby was four days old that he should have the BCG anyway. Emma and their two daughters were tested for TB but much to everyone's relief they all tested negative.

Giles took four weeks off work to convalesce at home and slowly built up his strength pottering about and "doing a bit of DIY". The episode has left him feeling slightly debilitated. But he is now fitter, and enjoying the odd glass of wine.

Information on TB is available from the British Lung Foundation (0171- 831 5831).

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