S Adalat, M Paliwalla, V Novelli, and F A I Riordan

A survey of tuberculosis services in the UK
Arch Dis Child 2008; 93: 575-577 [Abstract] [Full text] [PDF]

b.kampmann{at}imperial.ac.uk Beate Kampmann, et al.

We read with interest the review of TB services for children in the UK by Adalat et al. Although the survey was conducted several years ago and prior to the publication of the recent NICE guidelines, several key issues mentioned in the article continue to impair the care for children with TB in the UK: - Tuberculosis in children remains an under-appreciated condition and is not sufficiently prioritized in public health planning. - unified approaches to diagnosis and management of latent infection in children are still lacking. - few hospitals can provide negative-pressure cubicles required for isolation of children with active disease (who's carers might also be infected). This shortage will become more and more pressing, as MDR TB cases continue to rise in adults and have started to affect children. - management of TB as a family disease requires good communication between chest physicians and designated paediatricians, and in our own experience, TB nurses with paediatric experience often provide that crucial link. - development of clinical and research networks will be important particularly in assessing the diagnosis and management of children supposedly latently infected with TB, as practice continues to vary widely both within the UK and in Europe. Networks will also be important for the management of more complex cases of TB or those with MDR TB which will need involvement from those with greater experience, such as adult physicians or designated paediatricians.