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Tuberculosis in the United Kingdom and Republic of Ireland
  1. Stephen SS Teo (teosss{at}yahoo.com)
  1. Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, United Kingdom
    1. Andrew Riordan
    1. Royal Liverpool Children’s Hospital, United Kingdom
      1. Mazin Alfaham
      1. Llandough Hospital, United Kingdom
        1. Julia Clark
        1. Newcastle General Hospital, United Kingdom
          1. Meirion R Evans
          1. Communicable Disease Surveillance Centre, Cardiff, United Kingdom
            1. Mike Sharland
            1. St George's Hospital, United Kingdom
              1. Vas Novelli
              1. Great Ormond Street Hospital, United Kingdom
                1. John M Watson
                1. Health Protection Agency, United Kingdom
                  1. Pam Sonnenberg
                  1. University College London, United Kingdom
                    1. Andrew Hayward
                    1. University College London, United Kingdom
                      1. John Moore-Gillon
                      1. St Bartholomew's Hospital and Royal London Hospital, United Kingdom
                        1. Delane Shingadia (shingd{at}gosh.nhs.uk)
                        1. Great Ormond Street Hospital, United Kingdom

                          Abstract

                          Aims: To describe the clinical features, diagnosis, and management of children with tuberculosis in the United Kingdom and Republic of Ireland.

                          Methods: Cases of culture-confirmed and clinically diagnosed tuberculosis were reported to the British Paediatric Surveillance Unit from December 2003 to January 2005.

                          Results: In total, 385 eligible cases were reported. Pulmonary disease was present in 154 (40%) children. Just over half (197, 51%) of children presented clinically and most of the remainder (166, 43%) at contact tracing. A probable source case was identified for 73/197 (36%) of the children presenting clinically. The majority (253, 66%) of children had a microbiological and/or histological investigation, and culture results were available for 240 (62%) children, of whom 102 (26%) were culture-positive. Drug resistance was reported in 15 (0.4%) cases. Forty-four percent (128/292) of non-white children did not receive the recommended quadruple drug therapy. Seven children died. Only 57% (217) of children were managed by a paediatric subspecialist in respiratory or infectious diseases or a general paediatrician with a special interest in one of these areas. Fewer than five cases were reported from 119/143 (83%) respondents and 72 of 96 (75%) centres.

                          Conclusions: Many paediatricians and centres see few children with tuberculosis. This may affect adherence to national guidelines. Managed clinical networks for children with tuberculosis may improve management and should be the standard of care.

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