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PubMed1994

Essentials of tuberculosis control for the practising physician. Tuberculosis Committee, Canadian Thoracic Society.

OBJECTIVE: To recommend guidelines for the management of tuberculosis (TB), particularly in high-risk groups including poor and homeless people, aboriginal Canadians, immigrants from countries where TB is highly prevalent and people with HIV infection. OPTIONS: Diagnosis, pharmacotherapy, vaccination and chemoprophylaxis. OUTCOMES: Prevention of infection and diagnosis and cure of TB. EVIDENCE: The evidence was gathered in late 1992 from previous guidelines, recommendations by specialist societies and new studies. VALUES: Evidence was categorized into four levels: I, randomized clinical trials of therapeutic interventions or prospective studies of diagnostic strategies; II, case-control studies; III, retrospective descriptive studies; and IV, consensus of the committee members and published statements. The Tuberculosis Committee of the Canadian Thoracic Society comprises experts in TB from across Canada. BENEFITS, HARM AND COSTS: The benefits of early diagnosis and prompt initiation of therapy are well documented. The cost effectiveness of antituberculous therapy in developing countries is well documented. In developed countries chemoprophylaxis has been shown to be cost effective, and directly observed chemotherapy has recently been hypothesized to have economic benefits. RECOMMENDATIONS: In the appropriate clinical setting, particularly when patients are known to be at high risk of TB, clinicians should consider TB, reserve body secretions for mycobacteriologic tests and conduct other investigations such as chest radiography. Furthermore, if TB is strongly suspected or confirmed by appropriate investigation the early initiation of multi-drug therapy, including at least three first-line drugs, is strongly recommended. If drug resistance is suspected a regimen of four to five drugs, including at least two drugs with which the patient has not been treated, should be started. If the strain is found to be resistant to any of the drugs in the regimen appropriate changes should be made. Chemoprophylaxis should be considered especially in contacts with a recent significant reaction to the purified protein derivative (PPD) skin test and in people known to be at risk of reactivated TB infection, particularly those with HIV infection and a significant PPD skin-test result. Vaccination with bacillus Calmette-Guérin should be limited to high-risk groups, particularly aboriginal Canadians living on reserves. VALIDATION: These recommendations are based on a consensus of Canadian experts supported by other specialist societies and reference groups. They have been reviewed by the Standards Committee of the Canadian Thoracic Society. SPONSOR: The Canadian Lung Association and the Tuberculosis Committee of the Canadian Thoracic Society.

Algorithms↗
PubMedDate not supplied

Extrapulmonary tuberculosis in an immigrant society: clinical and demographic aspects of 92 cases.

Extrapulmonary tuberculosis accounted for 33% of all new cases of tuberculosis identified at the Soroka Medical Center in Beer Sheva, Israel, during a 10-year period. The most common types of extrapulmonary infection diagnosed were genitourinary tuberculosis (54% of patients), lymphadenitis (13%), pleural tuberculosis (9%), and tuberculosis of bones and joints (8%). Of 92 patients, 51% were Jews of Ethiopian origin, 29% were Jews of non-Ethiopian origin, and 20% were Bedouins. Thus, extrapulmonary tuberculosis remains a significant problem for Israel's heterogeneous population.

Ethiopia↗
PubMed1999

Drug-resistant pulmonary tuberculosis in Israel, a society of immigrants: 1985-1994.

SETTING AND OBJECTIVES: Drug-resistant tuberculosis was uncommon in Israel until 1985, when the waves of immigration began. We studied the incidence and clinical course of resistant pulmonary tuberculosis nationwide. DESIGN: Isolates of Mycobacterium tuberculosis between 1985 and 1994 were surveyed. Data on 150 patients with resistance and 110 patients with drug-sensitive disease were reviewed. Ethnic origin, type of resistance, radiological findings and outcome were analysed. RESULTS: In total, 16.7% of the isolates showed resistance to at least one drug; 58% had resistance to multiple drugs. In 67% of the patients the resistance was primary. Most patients were immigrants from the former USSR and from Ethiopia; none were Israeli-born Jews. Mortality with resistance was 10%, and was highest (14%) with multiple drug resistance. Mortality among drug-resistant cases was lowest (3%) among Ethiopian Jews. Cavities and extensive disease were more common with drug resistance. CONCLUSION: Drug resistance has become relatively common in Israel due to immigration from the former USSR and Ethiopia. It is more extensive radiologically and carries a poorer outcome.

Drug Resistance, Microbial↗
PubMed2000

Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Joint Tuberculosis Committee of the British Thoracic Society.

BACKGROUND: The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. METHODS: A subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of the British Thoracic Society to revise the guidelines published in 1994 by the JTC, including representatives of the Royal College of Nursing, Public Health Medicine Environmental Group, and Medical Society for Study of Venereal Diseases. In preparing the revised guidelines the authors took account of new published evidence and graded the strength of evidence for their recommendations. The guidelines have been approved by the JTC and the Standards of Care Committee of the British Thoracic Society. RECOMMENDATIONS: Tuberculosis services in each district should have staffing and resources to fulfil both the control and prevention recommendations in this document and to ensure adequate treatment monitoring. Notification of tuberculosis is required for surveillance and to initiate contact tracing (where appropriate). The following areas are discussed and recommendations made where appropriate: (1) public health law in relation to tuberculosis; (2) the organisational requirements for tuberculosis services; (3) measures for control of tuberculosis in hospitals, including segregation of patients; (4) the requirements for health care worker protection, including HIV infected health care workers; (5) measures for control of tuberculosis in prisons; (6) protection for other groups with potential exposure to tuberculosis; (7) awareness of the high rates of tuberculosis in the homeless together with local plans for detection and action; (8) detailed advice on contact tracing; (9) contact tracing required for close contacts of bovine tuberculosis; (10) management of tuberculosis in schools; (11) screening of new immigrants and how this should be performed; (12) outbreak contingency investigation; and (13) BCG vaccination and the management of positive reactors found in the schools programme.

Aerospace Medicine↗