Management of tuberculosis in a British inner-city population

Abstract

UK and US guidelines for TB imply out-patient management as the norm. Our study shows a very high rate of in-patient care, largely a consequence of the emergency admission of acutely ill, previously undiagnosed cases. There are public health implications in terms of spread of infection from individuals with advanced disease. The high utilization of expensive in-patient resources has significant implications for purchasers and providers of care for TB in socio-economically deprived areas. Further, the cost-effectiveness of public health interventions aimed at limiting the spread of TB should be assessed by reference to this true, high cost of managing TB, not a low cost based on false assumptions about rates of out-patient versus in-patient care.

Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey

“…The dominant mode of referral by patients in our study was self-referral through the A&E Department; this supports findings from one other study that reported most patients with tuberculosis at one London hospital being admitted acutely ill via self-presentation to the A&E Department, most previously undiagnosed [22]. The authors report that the utilisation of expensive in-patient resources has significant implications for purchasers and providers of care in socioeconomically deprived areas.…”

Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners

“…and TB treatment-related hepatotoxicity in this group reinforces potential underdosing and the development of drug resistance. Standard doses of rifampicin have been low in previous Russian treatment guidelines [25,26], with a discontinuation of treatment occurring at lower levels of liver function test abnormality than, for example, that which is recommended in UK and USA guidelines [27][28][29][30][31]. Prisoners will be released at the end of their sentence (as in Western European countries), and, if treatment is not completed, therapy will be continued in the civilian sector, although many patients are lost to follow-up.…”

Case report: management of occult tuberculosis infection by 2-stage arthroplasty of the elbow

“…This condition is now known as tuberculosis. 11 TB can affect any tissue in the body. Joint involvement is common and is characterized by effusion, pain, and swelling.…”

“…11 In February 2002 the wound was healed and the patient's serologic indices were normal. A second-stage reimplantation was performed by use of a Coonrad-Morrey total elbow prosthesis ( Figure 2).…”