A Medical Meander

Here's a bit from the professional side of my job.  Warning: longish medical post.  

TB in the right upper lobe, last week.

"Bugs", or bacteria, are interesting and for such  'simple' organisms, they're awfully complex.   Here's a tidbit - maybe not dinner party conversation, but interesting all the same - the first dose of antibiotics in a typical infection often kills over 95% of the bacteria.  All the remaining days of treatment are spent just mopping up.  This mopping-up may be due to bacteria that are hiding in an anatomically protected place, are partially resistant, or are simply tolerant of the antibiotic because of the slow-growth phase they are in (some antibiotics only kill rapidly growing bacteria).  So the interesting bit: bacteria that end up in sub-optimal areas of your body, places where they have a hard time growing, are often more likely to survive the initial few doses.  Always finish your course of antibiotics!

TB is not typical.  Very slow growing to begin with, it is inherently resistant to most common antibiotics and it grows slowly enough that you might say it has the time to develop resistance to antibiotics: if you make the mistake of treating it with just one, or even just two antibiotics, no dice.  No, you have to hit it with four separate antibiotics simultaneously to kill it.   And if you ease up on it at all, e.g. you stop after six weeks of treatment, the few remaining bacilli in those sub-optimal locations raise their heads, see the coast is clear, and begin reproducing again; you relapse.  This is why it takes 6 or more months to treat run-of-the-mill, fully-sensitive TB.  Let's not talk about drug-resistant TB.

TB also is interesting because of its long history and its predilection for growing in weird places.  One place, the lymph nodes of the neck, has a fun historical name: Scrofula - it's just fun to say.  Try referring to someone as "an ill-favored, scrofulous knave" and even though no one will have any idea what you're talking about, they'll know just what you mean and will probably think you've been reading too much Shakespeare.

Scrofula is one of a select few historical illnesses where I just like the names: scrofula, marthambles, scurvy, the falling damps, dropsy, hockogrockle*, and my all-time-favorite - thundering apoplexy.




*Marthambles, the falling damps and hockogrockle are not actually real diseases - they were illnesses claimed to be cured by quacks & cure-alls in the early 18th century.  But wouldn't you love to diagnose someone with 'the falling damps'?  Try it, the next time you have the chance.