title: Tuberculosis in an area bordering east London: significant local variations when compared to national data.
abstract: From September 1996 to June 1997, in an area bordering East London, we prospectively collected epidemiological, clinical and microbiological data on all patients with newly diagnosed culture-positive tuberculosis and compared these to national data based on notifications. The significant differences were that tuberculosis was diagnosed almost exclusively in non-Caucasian patients (42/47 [89%]) and that there was a high percentage of extrapulmonary tuberculosis (27/47 [57%]) including four cases of tuberculous meningitis and five cases of osteomyelitis. We also observed that 19/27 (70%) of patients with extrapulmonary tuberculosis had normal chest X-rays, 3/17 (18%) sub-Saharan Africans were HIV antibody-positive and drug resistance strains were isolated from six sub-Saharan Africans and one Caucasian. Figures for treatment failures and mortality compared favorably to national averages at 6 months. National data do not accurately reflect local epidemiology and clinical presentations. Hospital-based surveillance and promoting awareness of local differences is essential to prevent delayed diagnosis, inappropriate management and poor clinical outcome.
authors.affiliation: Dept. of Microbiology, St. Thomas' Hospital, London, UK. mark.melzer@gstt.sthames.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Melzer
authors.forename: R A
authors.initials: RA
authors.lastname: Storring
authors.forename: L R
authors.initials: LR
authors.lastname: Bagg
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000208:ethnology; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D014376:Tuberculosis / Q000453:epidemiology* / Q000208:ethnology; D020306:Tuberculosis, Central Nervous System / Q000453:epidemiology; D014394:Tuberculosis, Osteoarticular / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology