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Could it be, TB?

23 July

“We can’t just sit in clinic and expect people to come to us. If they don’t turn up and we suspect they’re in trouble, we’ll go out and find them…”

Lead TB specialist nurse David Thomas has 20 years’ experience helping to fight one of the oldest infections known to man. Together with Susie Barrett, they make up the RBCH and East Dorset TB Team.

The duo are keen to bring TB to the attention of clinicians and GPs to get them considering TB as a potential diagnosis, especially as the disease remains in the top 10 global killers.

“There is no country without TB and while the rates are dropping in some of the UK’s bigger cities, in areas with fewer TB resources such as Dorset, they’re not,” says David.

“TB is strongly linked to poverty and underserved communities. For some people, accessing healthcare is a lower priority, especially if they’re working extremely hard and sending money home or struggling to buy food or find shelter. Unfortunately their health comes last.”

Nationally, 70% of people suffering with active TB are born outside the UK and are often working long hours to support their families, becoming run down and reigniting latent TB that may have been lying dormant in their bodies for several years. The other 30% of cases include those with specific risk factors for TB, such as homeless people, those with drug and alcohol addictions, former prisoners and those who are otherwise immunosuppressed.

There are different types of TB – active TB which if it’s in the lungs or throat may be infectious, and sleeping/latent TB where the immune system holds it at bay. Globally 1:3 people are infected with latent TB of which around 10% will go on to develop the active disease.

Standard TB is completely treatable and 95% of people will get better. However some forms of TB are drug resistant and require much longer treatments, sometimes up to two years, and patients can often be in hospital for long periods of time.

TB symptoms include a cough lasting more than three weeks, severe fatigue, unexplained weight loss, day fevers, reoccurring drenching night sweats and swollen lymph nodes. TB should be considered and investigated in all patients with these symptoms especially if they also come from a high risk group. Unfortunately having the BCG jab doesn’t mean you’re immune.

David and Susie are keen to see new entrant TB screening commissioned locally, provided during university fresher’s weeks and proactively offered when those from high risk groups engage with health providers.

“We’ve had 20 cases from students over 10 years,” Susie explains, adding: “We had a young guy from India who came here to do his degree and was later diagnosed with multidrug resistant TB. He would’ve died if he was sent home but now he’s cured. He went through 18 months of tough treatment but we got there.”

The team has had a number of success stories due to the effort they put in to treat people. They recalled a recent patient with alcohol addiction who had lived on the streets for 15 years. They got him emergency accommodation, moved him away from Boscombe and got him through treatment with the help of the drug and alcohol team. He regained weight and rediscovered his love of reading, so much so he ended up assisting with proofreading a research proposal by the team.

Recently they also treated a homeless Polish man for TB, managed to reunite him with his son and find funding for accommodation and food. It was his case that sparked the idea to do a larger screening among the homeless community, as the team were aware he could’ve infected others.

David says: “It’s a fantastic job. We love it. If our service wasn’t there, a case of TB could quickly become catastrophic.”

TB screening for the homeless

On Wednesday 8 May, David and Susie helped to screen the local homeless population for TB. They advertised the screening through homeless services and charities and a fleet of 15 vehicles brought homeless people from across Bournemouth, Poole and Christchurch to the Salvation Army church in Boscombe.

The team were expecting 40 people at most, but some 138 homeless people turned up on the day and were screened using a mobile x-ray van, hired from London, and a modern blood test that can detect TB in the body. The team looked for abnormal chest x-rays and filtered patients for urgent assessments.

Of all those screened, 17 were found to have abnormal chest x-rays, 13 had positive blood tests for latent TB and one was diagnosed with cancer, and is now receiving palliative care.

The council’s housing team and our hospital’s Liver Team also attended on the day to check for hepatitis C, B and HIV. In addition, a local drug and alcohol team, GP and mental health team provided 1:1 consultations.

Susie says: “It was quite daunting seeing everyone but we screened them one at a time. The success was down to the team working and the local homeless volunteers rounding up so many people. They did a fantastic job.

“It was a wonderful sense of achievement. It broke down the barriers and made you realise things like this are achievable. Hopefully we’ll be able to do it again soon.”


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