Awareness Of Tuberculosis Research Articles

Family demography in a remote rural community in Zambia.

A community survey was conducted in a remote rural area of Zambia by The Kasanka Trust whose aims in running a National Park are to include aid to the community living around its borders. Selected results have been extracted from a general report by the Kasanka Trust, including awareness of HIV infection and tuberculosis. The remarkable population dynamics found in this apparently impoverished, poorly served community is highlighted.

Intestinal tuberculosis: return of an old disease.

Tuberculosis (TB) can no longer be considered a rare disease in the United States due, in part, to the AIDS epidemic. Because the signs and symptoms of intestinal TB are nonspecific, a high index of suspicion must be maintained to ensure a timely diagnosis. The aim of this article is to review the history, epidemiology, pathophysiology, and treatment of TB. This review is based on an examination of the world literature. In only 20% of TB patients is there associated active pulmonary TB. Areas most commonly affected are the jejunoileum and ileocecum, which comprise >75% of gastrointestinal TB sites. Diagnosis requires colonoscopy with multiple biopsies at the ulcer margins and tissue sent for routine histology, smear, and culture. If intestinal TB is suspected, empiric treatment is warranted despite negative histology, smear, and culture results. Treatment is medical, and all patients should receive a full course of antituberculous chemotherapy. Exploratory laparotomy is necessary if the diagnosis is in doubt, in cases in which there is concern about a neoplasm, or for complications that include perforation, obstruction, hemorrhage, or fistulization. This review draws attention to the resurgence of tuberculosis in the United States. An increased awareness of intestinal tuberculosis, coupled with knowledge of the pathophysiology, diagnostic methods, and treatment should increase the number of cases diagnosed, thus improving the outcome for patients with this disease.

Diagnostic problems of tuberculous cervical adenitis (Scrofula)

Purpose: This study was designed to review the diagnostic procedure for tuberculous cervical adenitis and propose a simple protocol for the work-up of patients with suspected tuberculous cervical adenitis. Moreover, it served to increase physician awareness of tuberculosis as possible cause of cervical mass. Patients and Methods: We performed a retrospective study of 57 patients with tuberculous cervical adenitis who were treated at North West Armed Forces Hospital, Tabuk, Saudi Arabia between March 1989 and April 1993. The results of diagnostic procedures, chest x-ray, tuberculin test, fine-needle aspiration, microbiology culture, and histopathology were reviewed. Results: Forteen percent showed changes in chest x-ray, 92% had positive tuberculin test, and 50% of the culture material grew Mycobacterium tuberculosis. All specimens for histopathology were suggestive of tuberculosis. Conclusion: A thorough history and physical examination, tuberculin test, and fine-needle aspiration will help arrive at an early diagnosis of tuberculous cervical adenitis and allow early commencement of treatment before final diagnosis can be made by incisional biopsy and culture. Tuberculosis should be included in the differential diagnosis of neck mass.

Miliary tuberculosis in a high prevalence area of the U.K.: Blackburn 1978–1993

Thirty-nine cases of miliary tuberculosis treated between 1978–1993 in a district with a high incidence of tuberculosis are reported. Twenty-eight patients were of Indian Subcontinent (ISC) ethnic origin, 10 patients were Caucasian and one patient was Chinese. Mortality at 10% in both Caucasian (x 2 4·94; 0·05> P>0·01) and ISC patients (x 2 10·22; 0·001>P) were significantly lower than in a recently reported series from Edinburgh, as was the proportion of post mortem diagnoses of miliary tuberculosis (x 2 6·35; 0·02>P>0·01). Both the rate of miliary tuberculosis and the average age at diagnosis in Caucasian patients were lower than in the Edinburgh series suggesting that miliary tuberculosis could be under-diagnosed in the elderly Caucasian population in the Blackburn district. The better outcome of those diagnosed in life may be partly due to heightened awareness of tuberculosis locally and partly due to treatment by a centralized tuberculosis service.

Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis

Setting: The mortality and morbidity from childhood tuberculosis may be influenced by the delay from the time of first symptoms until the start of and compliance with treatment. Objective: This study investigated these delay periods and the compliance with therapy in children with tuberculosis. Design: During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO criteria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notification until therapy 0.9 weeks. 16% of children notified as having tuberculosis never received therapy. Significantly fewer children in the urban squatter communities received therapy than in urban settled ( P = 0.02), rural agricultural ( P = 0.0001) and rural settled ( P = 0.09) communities. 12% of children did not complete their therapy. Conclusion: The delay in presentation (‘patient delay’) was shorter than the delay in diagnosis (‘doctor delay’). Failure to trace children and to complete therapy was particularly likely to occur in urban squatter communities. Easier access to health care facilities may shorten the ‘patient delay’ while greater awareness of tuberculosis and proper investigation of children may shorten the ‘doctor delay’.

Tuberculosis diagnosis and treatment of young South African children: experiences and perceptions of care-givers

Setting: Tuberculosis (TB) in infants and young children is a major public health concern in South Africa. As care-givers of young children often supervise TB treatment, we explored their experiences and perceptions of TB. Objectives: To ascertain TB awareness, feelings about and problems with the treatment and perceptions of TB health education among care-givers of young children being treated for TB. Design: An interview schedule with closed and open-ended items was designed to obtain care-giver information on background details, TB awareness, feelings and problems with the treatment, and perceptions of TB health education. Two trained interviewers administered the schedule. Responses were analysed descriptively. Responses to open-ended items were grouped into common themes and given conceptual labels. Results: 51 care-givers (36 black, 11 coloured and 4 white) were interviewed. Only 8 suspected that their children had TB, but 23 sought medical attention for the classic signs/symptoms of TB. The majority had positive feelings about the treatment and felt relief/happiness due to improvement in the child's physical health. The major problems with TB therapy were the child's refusal to take the medication and distance to the clinic. Out of the 41 care-givers who acted as supervisors of TB treatment, 9 had received TB health education at a clinic, usually once, through a talk. The most important parts were giving the child treatment as prescribed and signs/symptoms of TB. Conclusions: Care-givers had a low level of TB awareness, but were very concerned about their children's health. There is a vast discrepancy between system and care-giver perspectives on TB health education, requiring immediate and radical action.

TUBERCULOSIS: An Epidemic in Older Adults

The incidence of tuberculosis is disproportionately high in our elderly population. This group appears to be at high risk because many were infected early in life. Additional factors contributing to increased risk in the elderly probably include low clinical suspicion for tuberculosis in this age group, unusual or nonspecific clinical and roentgenographic presentations, difficulties in interpreting the tuberculin skin test, and the presence of associated illnesses that may lead to delay in diagnosis. Failure to diagnose tuberculosis in this population has important public health implications, particularly in nursing homes and long-term care facilities. Tuberculosis is usually easily diagnosed when suspected in elderly patients, and effective therapy is available for prevention and treatment of this disease. The special needs of old patients must be considered when these regimens are applied. Increased awareness of tuberculosis in the elderly is important for the success of strategies that have been developed to eliminate tuberculosis from the United States. As our population continues to age, physicians who treat the elderly must be vigilant in suspecting tuberculosis as a cause of illness in these patients.

Tuberculosis Control

Specialized facilities for tuberculosis (TB) have all but faded from the American health care system. With the introduction of isoniazid and other effective therapies, patients with TB became part of the mainstream of patients treated in general care hospitals and outpatient settings. This success, however, caused the awareness of TB to decrease among health care providers and the public. This complacency has now come to an abrupt halt with the heavily publicized outbreaks of multidrug-resistant strains of<i>Mycobacterium tuberculosis</i>in New York and Florida.¹Public awareness and fear of TB has been heightened through media coverage, including a recent cover story in<i>Newsweek</i>entitled "TB: Why It's Back and How We Can Protect Ourselves" (<i>Newsweek</i>. March 16,1992: 52-57). The fear of widespread dissemination of TB to other patients, health care workers, and the general public has prompted interest in reopening special TB facilities. But would these facilities, in fact,

Experience with tuberculosis in a public teaching hospital

Over a five-year period, 108 patients with active tuberculosis were admitted to the Talmadge Memorial Hospital in Augusta, Georgia. The age, sex and race distribution, case-fatality ratio, and primary drug resistance data did not differ from the national experience. The high incidence of nonpulmonary infection sites (31 percent) serves to emphasize that all hospital services and medical specialities can expect to encounter active tuberculosis. The only detected cluster of cases was from the state prison. The fact that the disease was not diagnosed or managed effectively in seven of 12 inmates emphasizes its special problem. Delays in diagnosis seemed to be unjustified in 11 patients; seven of these delays resulted from remediable human error. Four delays in diagnosis were due to difficulties that could be corrected by maintaining a greater awareness of tuberculosis and broadening the differential diagnosis to include tuberculosis among patients at high risk.

Adult-onset pulmonary tuberculosis.

Medical records and radiographs of 103 adults with primary tuberculosis were reviewed. The shift toward delayed presentation appears to be related to decreasing childhood exposure and an increasing number of compromised hosts. Compared with classic "childhood" tuberculosis, there is a higher incidence of lower-lobe disease, but infiltrates also commonly involve the upper lobe or upper segments of the lower lobe. Adenopathy, cavitation, and tuberculoma are rare. If a pleural effusion is present and tuberculosis is suspected, pleural biopsy is mandatory. Adult respiratory distress syndrome can be a complication, particularly in miliary tuberculosis, and disseminated intravascular coagulopathy usually follows. A normal chest radiograph or clinical improvement of the patient with bed rest and penicillin does not exclude tuberculosis. Increased awareness of adult-onset tuberculosis on the part of radiologists could lead to a more rapid diagnosis and successful management.

A decade of skeletal tuberculosis.

Thirty-eight of 58 patients with skeletal tuberculosis (TB) reviewed were immigrants and 20 were of British indigenous origin. Spinal involvement i 28 cases was less common than involvement of peripheral joints, bones, or tendon sheaths (30 cases). Predisposing factors, including previous TB, were present in 70% of British patients and 31% of immigrants. Follow-up study of 23 cases showed that a complete clinical recovery of the skeletal disease was more likely in immigrants than indigenous cases and also in cases referred to hospital early. Immigrants presented usually within 5 years after arrival in Britain and at a younger age than indigenous cases; a quarter had within 5 sites of infection outside the skeletal system. Skeletal tuberculosis in the indigenous population remains very uncommon, and in half of these cases a history of previous TB was given. The need for continued awareness of skeletal TB is stressed, especially in immigrants, and also the importance of early diagnosis and institution of appropriate therapy.

Non-respiratory tuberculosis in Canada. Epidemiologic and bacteriologic features.

Of the total cases of tuberculosis reported in Canada between 1970-1974, approximately one-sixth (3671 cases) involved primarily non-respiratory organs. Common diagnostic entities were genitourinary tuberculosis (1516 cases), lymphadenitis (1083 cases), bone and joint tuberculosis (555 cases), gastrointestinal tuberculosis (155 cases) and meningitis (138 cases). The remainder (224 cases) involved a wide variety of organs. Between 1967 and 1977 the morbidity rates of most non-respiratory manifestations steadily declined, the decline in meningitis being particularly marked. In contrast, lymphadenitis did not decline to the same extent, reflecting changing immigration patterns. The major diagnostic entities differed in their age and sex patterns and in their contribution to total cases by birthplace and ethnic group. In particular, the preponderance of lymphadenitis in females, and in the Asian-born was striking. Mycobacterium bovis was isolated infrequently and bacillary resistance to antituberculosis drugs was also uncommon. In a substantial proportion of cases, active tuberculosis was present concurrently at another site, or there was historical or radiologic evidence of previous active tuberculosis. Despite this additional evidence, delay and failure of diagnosis were common. An increased clinical awareness of tuberculosis is required, particularly in view of the often enigmatic presentation of non-respiratory disease.

Awareness of tuberculosis.

Awareness of tuberculosis.

Tuberculin Testing in Minnesota Schools, Rural and Urban

A mass intradermal tuberculin testing program is feasible and can be applied to large numbers of school children. This is a means of monitoring a large portion of a population group for tuberculous infection. Its side effects are the awakening of the public's awareness of tuberculosis as a disease which is still with us, the realization by school systems that they can contribute greatly to such public health measures of control and case finding, the gaining of experience by nursing groups in programs of inoculation, vaccination and skin testing which would be applicable to almost any emergency program, either local or national.

Reduction of Irregular Discharge Rates in a Tuberculosis Hospital: Impact of a Coordinated County Health Department and Tuberculosis Hospital Program Upon Unapproved Discharges.

Of 1,097 patients discharged from the tuberculosis department of a public county hospital within a 12-year period, 122 left against medical advice. Disapproved discharges decreased from 88 (24.3 per cent) in the first six years to 34 (9.5 per cent) in the second six years. Open, infectious patients numbered 42 (47.8 per cent) of 88 in the first group and 10 (29.4 per cent) of 34 in the second group. Reasons for this favorable change are: development of an active city-county health department under a full-time director, initiation of a home-care plan and abbreviated hospitalization, constant awareness of tuberculosis as fundamentally a communicable disease, requiring: intimate coordination of hospital, home, medical, nursing, and public health services.