Tuberculosis in UK cities: workload and effectiveness of tuberculosis control programmes

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) has increased within the UK and, in response, targets for TB control have been set and interventions recommended. The question was whether these had been implemented and, if so, had they been effective in reducing TB cases.</p> <p>Methods</p> <p>Epidemiological data were obtained from enhanced surveillance and clinics. Primary care trusts or TB clinics with an average of > 100 TB cases per year were identified and provided reflections on the reasons for any change in their local incidence, which was compared to an audit against the national TB plan.</p> <p>Results</p> <p>Access to data for planning varied (0-22 months). Sputum smear status was usually well recorded within the clinics. All cities had TB networks, a key worker for each case, free treatment and arrangements to treat HIV co-infection. Achievement of targets in the national plan correlated well with change in workload figures for the commissioning organizations (Spearman's rank correlation R = 0.8, P < 0.01) but not with clinic numbers. Four cities had not achieved the target of one nurse per 40 notifications (Birmingham, Bradford, Manchester and Sheffield). Compared to other cities, their loss to follow-up during treatment was usually > 6% (χ²= 4.2, P < 0.05), there was less TB detected by screening and less outreach. Manchester was most poorly resourced and showed the highest rate of increase of TB. Direct referral from radiology, sputum from primary care and outreach workers were cited as important in TB control.</p> <p>Conclusion</p> <p>TB control programmes depend on adequate numbers of specialist TB nurses for early detection and case-holding.</p> <p>Please see related article: <url>http://www.biomedcentral.com/1741-7015/9/127</url></p

More about the Deformation of Our Language

<div><p>Background</p><p>Although tuberculosis is transmitted by the airborne route, direct information on the natural output of bacilli into air by source cases is very limited. We sought to address this through sampling of expelled aerosols in face masks that were subsequently analyzed for mycobacterial contamination.</p><p>Methods</p><p>In series 1, 17 smear microscopy positive patients wore standard surgical face masks once or twice for periods between 10 minutes and 5 hours; mycobacterial contamination was detected using a bacteriophage assay. In series 2, 19 patients with suspected tuberculosis were studied in Leicester UK and 10 patients with at least one positive smear were studied in The Gambia. These subjects wore one FFP30 mask modified to contain a gelatin filter for one hour; this was subsequently analyzed by the Xpert MTB/RIF system.</p><p>Results</p><p>In series 1, the bacteriophage assay detected live mycobacteria in 11/17 patients with wearing times between 10 and 120 minutes. Variation was seen in mask positivity and the level of contamination detected in multiple samples from the same patient. Two patients had non-tuberculous mycobacterial infections. In series 2, 13/20 patients with pulmonary tuberculosis produced positive masks and 0/9 patients with extrapulmonary or non-tuberculous diagnoses were mask positive. Overall, 65% of patients with confirmed pulmonary mycobacterial infection gave positive masks and this included 3/6 patients who received diagnostic bronchoalveolar lavages.</p><p>Conclusion</p><p>Mask sampling provides a simple means of assessing mycobacterial output in non-sputum expectorant. The approach shows potential for application to the study of airborne transmission and to diagnosis.</p></div

Near-clinical applications of laser scanning cytometry

Biological samples from human tissues are characterized by complexity and heterogeneity. The ability to make rapid, reliable, quantitative fluorochromatic measurements on clinical samples allows the development of new and practical assays that could influence diagnosis and treatment in a variety of clinical applications. Laser scanning cytometry (LSC) is a very versatile and adaptable technology that allows for the quantitative analysis of cell samples that are unsuitable for flow cytometry by virtue of their presentation and context. Crucially, it allows the direct visualization of cells and rare events and the correlation of imagery with fluorochromatic measurements. In this chapter, we describe early experiments in the study of cytotoxic drug uptake and resistance in human tumor cells and in the study of sputum cells from asthmatic patients, which harness the specific capabilities of LSC to practical clinical problems.</p

Image analysis enhancement of the laser scanning cytometer

The laser scanning cytometer offers a range of novel applications and the capacity for direct visual validation of experiments through sample analysis on a microscope slide. Linkage of the instrument to an image analysis system through standard connections and software enhances the capabilities of the instrument in image capture and manipulation. In this technical note, we describe a simple linkage between the LSC and the Kontron KS 100 Image Analysis System, an example of a standard commercial image processing instrument.</p

A systematic literature review of machine learning applications for community-acquired pneumonia

Community acquired pneumonia (CAP) is an acute respiratory disease with a high mortality rate. CAP management follows clinical and radiological diagnosis, severity evaluation and standardised treatment protocols. Although established in practice, protocols are labour intensive, time-critical and can be error prone, as their effectiveness depends on clinical expertise. Thus, an approach for capturing clinical expertise in a more analytical way is desirable both in terms of cost, expediency, and patient outcome. This paper presents a systematic literature review of Machine Learning (ML) applied to CAP. A search of three scholarly international databases revealed 23 relevant peer reviewed studies, that were categorised and evaluated relative to clinical output. Results show interest in the application of ML to CAP, particularly in image processing for diagnosis, and an opportunity for further investigation in the application of ML; both for patient outcome prediction and treatment allocation. We conclude our review by identifying potential areas for future research in applying ML to improve CAP management. This research was co-funded by the NIHR Leicester Biomedical Research Centre and the University of Leicester.N/

Resuscitation-promoting Factors Reveal an Occult Population of Tubercle Bacilli in Sputum

Rationale: Resuscitation-promoting factors (Rpfs) are a family of secreted proteins produced by Mycobacterium tuberculosis (Mtb) that stimulate mycobacterial growth. Although mouse infection studies show that they support bacterial survival and disease reactivation, it is currently unknown whether Rpfs influence human infection. We hypothesized that tuberculous sputum might include a population of Rpf-dependent Mtb cells