Why do I suffer from brucellosis?

Dear Anita: Brucellosis is an animal disease (sheep, goats, cattle, pigs, dogs, and several others) that sometimes spills over to human beings and hence a zoonosis.
Brucellosis is an old disease which is getting more common because of increased public awareness and probably problems in laboratory diagnosis, among other reasons.

Most of the time, brucellosis may affect humans through taking unpasteurised milk, cheese and other dairy products or eating undercooked meat or direct contact with infected animals and rarely through air, childbirth, breast milk or sexual activity.
Bacteria in the blood, semen or placenta of an infected animal can cause human infection by entering through a cut on the skin which sometimes may be too small to be seen by our naked eyes (microscopic).
Brucellosis symptoms may include flu- like illness with fever, joint pains and fatigue and hence may be confused with other diseases.

To reduce the risk of getting brucellosis, one has to avoid unpasteurised dairy and products, cook meat thoroughly, wear gloves while handling sick or dead animals or animal tissue or when assisting an animal giving birth, vaccinate domestic animals against brucellosis and if one is a laboratory worker, handle all specimens with protection.
If one is affected, prompt treatment should be given.
Many people may be mistaken to have brucellosis because the tests done in Uganda look for the body’s reaction (antibodies) to a brucella germ.

Those who handle domestic animals may show a reaction without brucellosis and even after treatment, one may still show a reaction despite being completely cured of disease.
Sometimes, it may be necessary to grow germs in blood or bone marrow to confirm the diagnosis but this is costly and rare, with only a handful of laboratories in Uganda doing it.
Treatment for brucellosis with prescription drugs (antibiotics) may take at least six weeks, but the symptoms may take longer to go away completely. In some sufferers, the disease may return or turn chronic.

Dear Doctor: I have fever which is not going down with panadol and duocortexin. Can I take quinine?

Jaki Simon, Mubende

Dear Simon: You seem to be obsessed with fighting a fever which is actually beneficial since it is the body’s way of fighting invading germs or informing us of their presence when they cannot be seen with the naked eye. The body responds to germs, inflammations, or tissue destruction with a fever.
Instead of expelling this friend, it is necessary that this fever is properly investigated first, the cause eliminated, then the fever will be history.
Since the commonest cause of fever in Uganda is malaria, many people will take anti-malarial treatment whenever they feel a fever. This has greatly contributed to malaria germs getting resistant to various treatments.
Do not take quinine; see a doctor for proper management.

Dear Doctor: I have “swollen scars” which a doctor referred to as keloids. Can I get circumcised without getting keloids on my genitals?
Ivan

Dear Ivan: Circumcision is a safe surgical procedure performed for medical, cultural or religious issues.
It has minor complications such as bleeding, infection, diminished penile sensation; urethral injury and amputation of the penile head (glans) which are minimised when done by a qualified medical person.
A keloid is a big, hard scar which usually develops at the site of previously smaller injury such as surgical operation, pimples, insect bites, scratching or even burns.
Keloids can cause pressure problems, itching and anxiety due to cosmetic problems. Keloids develop most often on the chest, back, shoulders, and earlobes. They rarely develop on the genitals though in some people, they may develop on the pubis following razor shaving.
Keloid formation on the penis is very rare and when it happens, can create both aesthetic and functional (use) problems.

That said, it is difficult to understand the precise reasons why some people are more prone to developing keloids than others.
Therefore, it may be difficult to predict whether one will develop keloids or not even if they seem to run in families. What is also true is that one member of the family may be prone to developing keloids on the ear while others may get them on the chest whereas some may never develop them at all.

It is true that if one has keloids on other body parts, he is likely to develop them in an area where they are common, but keloids rarely affect the penis.
Prevention of the ugly scars is very important since current treatments are not always effective. The best way to prevent keloids is not to get any. Discuss your fears with your doctor because today, circumcision is necessary for more than one reason.

Dear Doctor: I used Injectaplan one year ago but I have failed to conceive. Are there any drugs to help me out?

Ivan

Dear Ivan: Injectaplan or Depo Provera is a progesterone-only synthetic hormone injection that is given every three months to prevent pregnancy.
It does so by stopping the ovaries from releasing eggs, causes the cervical mucus to thicken and changes the uterine lining, making it harder for sperm to enter or survive in the uterus or a fertilised egg to implant.
After the last shot of Depo Provera, it can take more than six months for the drug to leave the body. Side effects including irregular or no periods may linger on until the drug is completely gone.

Some women who want to become pregnant may stop using Depo Provera at any time and immediately get pregnant.
For others, it may take six to 18 months or longer for the body’s hormonal cycle to go back to normal and for a woman to conceive.
Though there is no evidence that the injection causes infertility, this method of birth control is not recommended for those who want to get pregnant quickly after discontinuing use.

Women who have not yet had children are, therefore, advised not to use this injection for family planning. Many women who fail to get pregnant may have got sexually transmitted diseases which may have blocked their fallopian tubes.
Also, many women who use contraception may have gone beyond the age of 30, after which getting pregnant becomes harder.
Family planning should always be possible after a couple is properly counselled about it and the decision taken with consideration of the problems that may be encountered in future. Please go back to your family planning clinic for advice.