Sue Jamieson

Pan Mersey TB Service

Abercromby Health Centre
Grove Street
Liverpool
L7 7HG

Tel: 0151 295 3874

Fax: 0151 702 9120
 The TB Team
Who are we and what do we do?
Our aim is to: Deliver Gold standard TB care to the populations of Liverpool,
Knowsley, Sefton and Southport

New Entrant

TB
Schemes
i th sts Education

Sc
k w ru HPA
n
Li ute T

r ee
c

ni
A w a ys with
PATIENT a th

ng
Patient Care P Prisons
Education local
SUPPORT

V
Contact tracing Mantoux testing and Org olunt
BCG vaccination for an i ar y
sat
adults and children ion
s

Homelessness MDT approach

Nurse Led TB clinics
THE BAD NEWS
• 8-9 million new cases/year. 2 million
deaths
• WHO estimates that 36 million people
will die by 2020 if not controlled.
• 8.5 thousand cases in UK 350 deaths
Increase of 27% over last 2 decades
• TB is the world’s biggest infectious
disease
• 1 in 3 of the world’s population is
infected
• Drug Resistance increasing
 Facts and Figures!
• In England the rate of TB is 13.8 per 100,000 of population

• 92% of cases for UK are reported in England.

• London has the largest proportion (39% of UK cases) with

the highest regional rate of 43.2 per 100,000 of population.

• 72% of cases were born outside the UK.

• Highest rates of TB were seen among non-UK born black

African and Indian / Pakistani / Bangladeshi ethnic groups.
THE GOOD NEWS
• TB is Curable
• Nearly half of all TB in UK is
from extra pulmonary sites
(non- infectious)
• Only 1 in 10 infected will go
on to develop disease
• Numbers have remained fairly
static in last 5 years
• Liverpool, Sefton & Knowsley
have a designated TB Team
and it’s growing!
 History of TB
• TB has been present in human population since antiquity.
• Skeletal remains show prehistoric humans (7000 BC) had TB.
• Tubercular decay found in spines of Egyptian mummies from 3000-
2400 BC.
• Around 460 BC, Hippocrates identified Phthisis (Greek term for TB)
most common widespread disease of the times.
• Mycobacterium tuberculosis (bacillus causing TB) identified by Robert
Koch in 1882.
• TB (consumption) caused most widespread public concern in 19th and
early 20th centuries as an endemic disease of the poor.
• In 1815, 1 in 4 deaths in England was of consumption.
• In 20th century TB killed an estimated 100 million people.
 WHAT IS TB?
• A tiny germ…Mycobacterium tuberculosis
• Enters body by droplet infection, like catching
a cold
• Affects lungs
– Lymph Nodes
– Kidneys
– Brain (TB meningitis)
– Bones
– Anywhere
 Transmission
• Breathing in infected
droplets from a person
with infectious TB
• Prolonged or repeated
exposure ( 8hrs)
• NOT via hard
surfaces, crockery,
touch etc.
 What next?
• No infection…body eliminates odd bacilli
• The bacilli can be rendered inactive by a
process of coating/calcification…..
• ….. in lungs or in other parts of the body
via lymphatic system
• The bacilli can multiply - Tuberculosis
 Aids to Diagnosis
• Symptoms
• Chest X-ray
• Laboratory Tests: Sputum etc
• Tuberculin Test: Mantoux
• History of contact/area of high TB
incidence/immuno-suppression
• Improve on Treatment
 SYMPTOMS
• Persistent Cough
• Night sweats/fever
• Weight loss
• Tiredness
• Persistent swollen
glands
CHEST X-RAY
TB Culture
Mantoux Testing

3
 How is it Treated?

• Medication…Only in last
60years
• Combination
• 6 months duration minimum
• Surgery
 RIFATER

PYRAZINAMIDE

E
IN
X
O
D
RI
PY
RIFINAH
T O L
MB U
ETHA

Isoniazid Rifampicin
Directly Observed Therapy
(Short term) DOTS
• Visits x 3 weekly

• Daily Visits

• Arrange for DOT

by another agent
 Latent TB Infection
• 1 in 3 infected
• Detected by a positive Mantoux test or IGRA
• Active TB ruled out…asymptomatic, normal CXR
• The body deals with the bacilli by rendering them
inactive, calcified coating
• There is no danger of infection to others
• Preventative treatment may be recommended
• 1 in 10 cases may activate during the lifetime of an
infected individual without treatment…usually when
immunity lowers due to age, disease or treatment.
• Importance of new entrant screening.
 Prevention
•Excellent Completion Rate
•Contact screening
•Preventative treatment
•Pro-active case-seeking
•BCG
Contacts
• Close contacts
• Vulnerability
• Stone in Pond
 Neonates of high risk groups
 Travellers… Travel Clinic
LSTM
 Negative Tuberculin reactors
young contacts
rough sleepers/homeless
asylum seekers
 High risk occupation
Case Seeking
• TB Contacts
• Positive Tuberculin
Testing
– Colleges /O’ Health
– Drop in/Hostels
– Homeless
– Drug/alcohol
• Overseas arrivals
 Short Quiz!
1. What is TB?
2. What are the signs and symptoms of TB?
3. What is Latent TB?
4. What is the vaccination to protect against TB called?
5. Who are at increased risk of TB?
6. How many people worldwide die each year?
a. 1-4 hundred thousand
b. 5-9 hundred thousand
c. 1 million plus
7. How many people in the UK get TB?
a. 1-3 thousand
b. 4-6 thousand
c. 7 thousand plus
8. How long is TB treated for?
9. How long has TB been around for?
 The Answers!
1. What is TB?
Answer: A bacterial disease caused by the bacteria Mycobacterium Tuberculosis.
An infectious disease.
2. What are the signs and symptoms of TB?
Answer: For Pulmonary TB; Persistent cough, Haemoptysis, Shortness of
breath, Chest pain, Pleural effusion. Other signs and symptoms can include:
poor appetite, weight loss, night sweats, fevers and enlarged lymph glands
3. What is Latent TB?
Answer: When a person is exposed to TB their immune system forms scar tissue
around the TB bacteria isolating it from the rest of the body, meaning that it
is non-infectious. Bacteria are in a dormant state in the body.
4. What is the vaccination to protect against TB called?
Answer: The BCG Vaccine (Bacillus Calmette-Guerin)
 The Answers continued
5. Who are at increased risk of TB?
Answer: New entrants from high risk countries, immunocompromised,
elderly, previous history of TB / Incomplete treatment,
contacts/previous exposure
6. How many people worldwide die each year?
Answer: WHO estimates worldwide nearly 2 million will die each year.
7. How many people in the UK get TB?
Answer: In the UK in 2007 the rate of tuberculosis (TB) infection
increased by 27% to 8417 cases.
8. How long is TB treated for?
Answer: minimum of 6 months but depending on the type of TB, up to 12
months
9 How long has TB been around for?
Answer: TB has been present in human population since antiquity
Pan Mersey TB Service
Abercromby Health Centre
Grove Street
Liverpool
L7 7HG

Tel: 0151 295 3874

Fax: 0151 702 9120