At a TB contact clinic at Sefton General Hospital the day after seeing Mac Dr Davies saw a middle-aged man who had

At a TB contact clinic at Sefton General Hospital the day after seeing Mac, Dr Davies saw a middle-aged man who had recently arrived from Bangladesh to join his family. An Aids patient may have infected four others and more than 50 people are being traced by 12 health authorities across the country.One way that MDR tuberculosis may arrive in the country is through immigration. Last month, the Independent reported what is believed to be the first UK outbreak of MDR tuberculosis at the Chelsea and Westminster Hospital, London. The WHO says death rates for some strains of multi-drug resistant (MDR) tuberculosis are higher than for the deadly Ebola virus, which has emerged in Africa, as well as some cancers.There have been numerous outbreaks of MDR tuberculosis in US cities but just a handful of cases in Britain - 42 last year But the risk of an outbreak is growing. They may then develop into highly dangerous, drug-resistant strains. Already under pressure to quit cigarettes, he knows he can't give up drinking, too "I might as well pack up life itself," he says. "We'll have to keep him in until we've worked out what to do," says Dr Davies.If drug treatment is incomplete, the consequences can be disastrous The bacilli can survive and multiply in the lungs.

If he is discharged now, what are the chances of him continuing to take the drugs? Mac is realistic The drugs can react with alcohol and cause liver damage. She usually relies on a family member or neighbour who will watch a patient take their drugs every day.In Mac's case that is not possible He drinks eight to 18 pints a night and lives alone. He is no longer infectious but will need a six-month course of three antibiotics to rid his body of the bacterium Mrs Williams can fit in a home visit only once a fortnight. People who may have been exposed to infection had to be traced, given a Heaf skin test, which indicates exposure to the TB bacillus, and possibly a chest X-ray.Mac's case also highlights how hard it is to treat the disease.

In a parallel incident in the US, one man with a highly contagious form of pulmonary TB infected 41 others in a Minneapolis bar - and 14 became seriously ill.In Mac's case, his contacts were spread around seven pubs, all within "staggering distance", says Ceridwen Williams, one of two TB nurses serving the city who co-ordinate the detective work. The outbreak was detected by chance when two members of the same club turned up as out-patients on the same day, and the link was made Four hundred people had to be called in for tests. Left untreated, someone with active TB can infect 10 to 15 people in a year. An outbreak at a social club in north Liverpool three years ago resulted in seven adults and one child becoming infected. TB is passed from one person to another in airborne droplets expelled in coughing or sneezing. Denmark, France, Italy, the Netherlands, Sweden and the UK all are reporting rises, due in part to immigration from high-prevalence countries, and increasing poverty and homelessness.In England and Wales, the rate of decline in TB notifications began to slow in 1985, reaching a low of 5,085 cases in 1987.