tuberculosis – basic concepts ursula oxley tb nurse specialist
TRANSCRIPT
Tuberculosis – Basic Concepts
Ursula Oxley TB Nurse Specialist
Some epidemiology…
TB rates in persons by age group, England and Wales, 1999 - 2004
UK born
Born abroad
Tuberculosis case reports by ethnic group (%), England and Wales, 1999 - 2004
World-wide epidemiology
• 3 million deaths from TB in 1995
• 95% cases of TB in developing countries.
• 98% of deaths from TB in developing countries.
• 75% of TB in developing countries in 15 - 50 age group.
(WHO guidelines for National Programmes 2nd edition 1997)
When should I suspect active tuberculosis
?
Anyone at high risk for TB and has symptoms of
• Weight loss• Fever,• Night sweats• Anorexia• Malaise• Cough (more than 3 weeks)• Enlarged lymph nodes commonly cervical and
mediastinal
Which people are considered high risk
?
• People born in high prevalence area 40/100,000 population
• Close contacts of a person with active PTB
• Previous or incomplete treatment for TB
• Immunocompromised (HIV, diabetes, chronic renal failure, chemotherapy, malignancy, corticosteroid use, young children)
• Homeless, institutionalised e.g. prison
• Alcohol or intravenous drug users
How should I manage suspected active tuberculosis
?
• Examination• Check contact/travel history• Exclude other conditions• Arrange CXR• Send 3 early morning sputum samples for
culture and microscopy – acid fast bacilli• Ring for advice or refer to TB Specialist
Services at NUH City Campus tel 0115 9628051 even before results are known
• Clinic appointment offered in same or following week
TB : Diagnostic tests…pitfalls
Sputum smear 50-70% +ve in pulmonary TB
Sputum culture 85-90% +ve in pulmonary TB
CXR Rarely, normal even in smear +ve (eg. endobronchial TB )
Heaf/Mantoux 68 – 83% +ve in pulmonary TB
17 – 32% false -ve
Difficulties of treatment and role of the TB Specialist Nurse
COMPLIANCE
TREATMENT COMPLETION
SIDE EFFECTS
How would you diagnose latent TB
?
Screening for latent TB in two instances:• Contact tracing – Specialist TB Service
mantoux/IGRA testing • Immigrant screening at port of entry and then local
referral to TB Specialist service OR at first registration in primary care – refer to TB
Specialist service Recent CXR (last six months) from high risk
countries with incidence < 40/100,000 CXR plus mantoux from high risk countries
< 500/100,000 e.g sub-Saharan Africa Mantoux only in children under 12 and pregnant
women IGRA testing if Mantoux positive* Treatment only offered to the under 35’s
Latent TB / TB infectionTuberculin reaction may be
positive for following• TB disease• Previous BCG• Atypical Mycobacteria • TB infection (Latent TB)
Mantoux test 1
Mantoux test 2
Mantoux test 3
End notes• TB remains a fascinating challenge
• Awareness and early referral to reduce transmission
• Direct referral to Specialist TB Services for advice and appointments tel/fax 9628051
• Choose and book not appropriate
• BCG has only been offered to high risk groups since 2005
Thank you!