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Management of tuberculosis in Wales: 1986–92
  1. Verghese Mathewa,
  2. Mazin Alfahama,
  3. Meirion R Evansd,
  4. Haydn Adamsb,
  5. Roger Verrier Jonesa,
  6. Ian Campbellc,
  7. Tony Jenkinse
  1. aLlandough Hospital and Community NHS Trust, Penarth, South Glamorgan, Department of Child Health, bDepartment of Radiology, cDepartment of Respiratory Medicine, dDepartment of Public Health Medicine, South Glamorgan Health Authority, Cardiff, ePublic Health Laboratory Service Mycobacterium Reference Laboratory, Cardiff Public Health Laboratory
  1. Dr M Alfaham, Department of Child Health, Llandough Hospital and Community NHS Trust, Penlan Road, Penarth, Vale of Glamorgan CF64 2XX.

Abstract

OBJECTIVES To describe the epidemiology of childhood tuberculosis in Wales and to assess the standard of management of patients with tuberculosis.

DESIGN Retrospective study of data retrieved from case notes and review of radiographs of all identified patients.

SUBJECTS Forty eight cases of tuberculosis and 10 of tuberculosis chemoprophylaxis in children under 15 years of age, in Wales, between January 1986 and December 1992.

MAIN OUTCOME MEASURES Management of childhood tuberculosis in Wales compared with the published recommendations of the Joint Tuberculosis Committee of the British Thoracic Society.

RESULTS Documentation was poor in most of the 48 cases of tuberculosis and only 31 (65%) were formally notified. One third of patients were asymptomatic and were detected by contact tracing; only eight (17%) were culture positive. Only 20% of patients from ethnic minorities had previously been immunised with BCG. Management and chemotherapy varied widely. Few patients were managed jointly by paediatricians and chest doctors. Only 10% completed treatment with a recommended chemotherapy regimen. In 37% of patients treatment was inadequate, and in the remainder either the choice of drugs or the duration of treatment was inappropriate. No patient died, nor had any relapsed by June 1995.

CONCLUSIONS Very few cases of childhood tuberculosis were managed according to the recommendations of the British Thoracic Society.

  • One third of patients with childhood tuberculosis were not notified

  • Most case of tuberculosis were in white children

  • Two thirds of patients had pulmonary disease; only two had tuberculous meningitis and none died

  • BCG immunisation status and tuberculin skin test results were poorly documented

  • Very few patients were jointly managed by paediatricians and chest doctors

  • Drug treatment was often inappropriate, either with respect to the choice of drugs or the duration of treatment

  • patient management
  • drug regimens
  • treatment recommendations

https://doi.org/10.1136/adc.78.4.349

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