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Mild or absent symptoms
A number of conditions will commonly present with mild symptoms, or in fact there be no symptoms at all. in this case it is quite likely that the patient will be unaware of any problems. A number of common examples are detailed below, and the table opposite gives some indication of the extent of under diagnosed conditions:
Toxoplasmosis
A protozoan infection that enters the body via the gut or broken skin. Cats are the primary host, and infection is by contact with cat faeces, or injestion of poorly cooke meat. The infection can pass to the brain, eyes and muscle, but in most cases there are no symtoms. It is also a source of obstetric problems.
Tuberculosis
Worldwide thsi causes more deaths than any other infectious agent, but is still not widely known about in the UK
Type II diabetes
Classically 'adult onset', it is due to impaired sensitivity to insulin rather than its lack. However, insulin may eventually be needed anyway. The onset of symptoms (ketones on breath, excessive thirst, excessive urination etc) is more gradual than in type I diabetes but the effects can be as serious. Increased screening may pick up a number of cases so it is important to be aware of the condition as a patient. For doctors problems such as lethargy or a poorly healing skin rash should suggest excluding diabetes by blood test (fasting blood glucose, 2 hour glucose tolerance test).
High Cholesterol
Increased awareness has led to routine screening; a blood cholesterol above 5.0 mmol/L is thought to be problematic. A number of studies have shown this to be a risk factor for cardiovascular disease (heart attack, stroke), but will usually be symptomless. Once genetic problems in cholesterol production have been ruled out, treatment is by lifestyle change (weight loss, HRT) and statin drugs.
Hypertension
A further cardiovascular risk factor that is again usually symptomless, although damage to the retina and other organs may be present. Routine screening should pick it up, but there is some disagreement about when to begin drug therapy. Generally, a sustained pressure of 160/100 mmHg should always be treated. Below this level other risk factors could be taken into account.
Osteoporosis
This is reduced bone density and is more prevalent in women. It can lead to crush fractures of the vertebrae or fracture of long bones such as the femur. A bone density scan can be diagnostic, although in many cases it but may only become apparent on x-ray after the patient has already suffered a fracture. Preventative measures include exercise, calcium supplementation and HRT.
Sexually transmitted diseases
A number of these conditions have slight or absent symptoms in many patients. For example many people can have herpes infection without developing the vesicles. Chlamydia infection is a particular problem as it often syptomless, but can lead to infertility
Haemochromatosis
This is a relatively common, inherited, disorder of iron metabolism. Increased intestinal absorbtion leads to the deposit of iron in multiple organs. Early stage disease can be asymptomatic, but eventually organ damage can be severe. It can be easily treated by regular venesection i.e. removal of blood.
Chronic renal failure
Damage to the kidneys is caused by a number of factors and will be irreversible. Unfortunately early signs may be slight (yellow skin, brown nails, bruising) but it is important to begin treatment as quickly as possible. Kidney damage should be ruled out in cases of hypertension. End stage disease can only be treated by transplantation.
Hypothyroidism
The symptoms can be vague such as tiredness, weakness, weight gain or constipation, and so the condition often overlooked. It should however be easily treatable with thyroxine. Hormone levels should be checked annually as osteoporosis is a theoretical risk in over treatment.
Glaucoma
Screening of intraocular pressure is important as the chronic condition can be present for some time with no symptoms. As the pressure inside the eyeball builds up beyond 21mmHg, damage to the eye become irreparable and visual field defects appear ('sausage shaped' scotomata). Treatment involves the reduction of this pressure by drug therapy or surgery.
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