03 - sue jamieson - tb talk for merseycare link nurses

8/8/2019 03 - Sue Jamieson - TB Talk for Merseycare Link Nurses

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Sue JamiesonPan Mersey TB Service

Abercromby Health Centre

Grove StreetLiverpoolL7 7HG

Tel: 0151 295 3874Fax: 0151 702 9120



The TB TeamWho are we and what do we do?

Contact tracing Mantoux testing andBCG vaccination for adults and children

Ed ucation

Nurse Le d TB clinics

New E ntrantSchemes

Our aim is to: Deliver Gol d stan d ar d TB care to the populations of Liverpool,Knowsley, Sefton an d Southport

P atientEducation

MDT approach

HPA

PATIENT

SUPPORT

Homelessness



THE BAD NEWS 8-9 million new cases/year. 2million d eaths

WH O estimates that 36million people will d ie by 2020if not controlle d .

8.5 thousan d cases in UK 350d eaths Increase of 27% over last 2 d eca d es

TB is the worl d¶s biggestinfectious d isease

1 in 3 of the worl d¶spopulation is infecte d

Drug Resistance increasing



Facts and Figures!In England the rate of TB is 13.8 per 100,000 of

population

92% of cases for UK are reported in England.

London has the largest proportion (39% of UK cases) withthe highest regional rate of 43.2 per 100,000 of population.

72% of cases were born outside the UK.

Highest rates of TB were seen among non-UK born black African and Indian / Pakistani / Bangladeshi ethnic groups.



THE GOOD NEWSTB is CurableNearly half of all TB in UK isfrom extra pulmonary sites

(non- infectious)Only 1 in 10 infected will goon to develop diseaseNumbers have remained fairlystatic in last 5 yearsLiverpool, Sefton & Knowsleyhave a designated TB Teamand it¶s growing!



History of TBTB has been present in human population since antiquity.Skeletal remains show prehistoric humans (7000 BC) had TB.Tubercular decay found in spines of Egyptian mummies from 3000-2400 BC.Around 460 BC, Hippocrates identified Phthisis (Greek term for TB)most common widespread disease of the times.Mycobacterium tuberculosis (bacillus causing TB) identified by RobertKoch in 1882.TB (consumption) caused most widespread public concern in 19 th andearly 20 th centuries as an endemic disease of the poor.In 1815, 1 in 4 deaths in England was of consumption.In 20th century TB killed an estimated 100 million people.



WHAT IS TB?A tiny germ«Mycobacterium tuberculosisEnters body by droplet infection, like

catching a coldAffects lungs ± Lymph Nodes ± Kidneys ± Brain (TB meningitis) ± Bones ± Anywhere



TransmissionBreathing in infecteddroplets from a person

with infectious TBProlonged or repeatedexposure ( 8hrs)NOT via hardsurfaces, crockery,touch etc.



What next?No infection«body eliminates odd bacilliThe bacilli can be rendered inactive by a

process of coating/calcification«..«.. in lungs or in other parts of the bodyvia lymphatic systemThe bacilli can multiply - Tuberculosis



A ids to Diagnosis

SymptomsChest X-ray

Laboratory Tests: Sputum etcTuberculin Test: MantouxHistory of contact/area of high TB

incidence/immuno-suppressionImprove on Treatment



SYMPTOMSPersistent Cough

Night sweats/fever Weight lossTirednessPersistent swollenglands



CHEST X-R AY



InfectiousOpen/Smear positive Tuberculosis



TB Culture



Mantoux Testing

3



How is it Treated?

Medication«Only in last

60yearsCombination6 months duration minimumSurgery



RIFATER

PYRAZINAMIDE

RIFINAH

RifampicinIsoniazid



Directly Observed Therapy(Short term) DOTS

Visits x 3 weekly

Daily Visits

Arrange for DOT by another agent



Latent TB Infection1 in 3 infectedDetected by a positive Mantoux test or IGRAActive TB ruled out«asymptomatic, normal CXRThe body deals with the bacilli by rendering theminactive, calcified coatingThere is no danger of infection to othersP reventative treatment may be recommended1 in 10 cases may activate during the lifetime of an infected individual without treatment«usuallywhen immunity lowers due to age, disease or treatment.Importance of new entrant screening.



PreventionExcellent Completion RateContact screeningP reventative treatmentP

ro-active case-seekingBCG



ContactsClose contacts

VulnerabilityStone in Pond



Neonates of high risk groupsTravellers« Travel ClinicLSTM

Negative Tuberculin reactorsyoung contacts

rough sleepers/homelessasylum seekers

High risk occupation



Case SeekingTB ContactsPositive TuberculinTesting ± Colleges /O¶ Health ± Drop in/Hostels ± Homeless

± Drug/alcohol

Overseas arrivals



The Answers!1. What is TB?Answer: A bacterial disease caused by the bacteria Mycobacterium Tuberculosis.

An infectious disease.

2. What are the signs and symptoms of TB?

Answer: For Pulmonary TB; Persistent cough, Haemoptysis, Shortness of breath, Chest pain, Pleural effusion. Other signs and symptoms can

include: poor appetite, weight loss, night sweats, fevers and enlarged lymphglands

3. What is Latent TB?

Answer: When a person is exposed to TB their immune system forms scar tissuearound the TB bacteria isolating it from the rest of the body, meaning that it

is non-infectious. Bacteria are in a dormant state in the body.4. What is the vaccination to protect against TB called?

Answer: The BCG Vaccine (Bacillus Calmette-Guerin)

03 - sue jamieson - tb talk for merseycare link nurses

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