Clinical update


Read our essential clinical update on a new tuberculosis quality standard from the National Institute for Health and Care Excellence (NICE).

Read our essential clinical update on a new tuberculosis quality standard from the National Institute for Health and Care Excellence (NICE)

Among the most common symptoms of TB is a cough that lasts for three
weeks or longer. Picture: iStock

Essential facts 
Tuberculosis (TB) is an infection caused by a bacterium, Mycobacterium tuberculosis. While it can affect any part of the body, only pulmonary TB is infectious. According to the charity TB Alert, there were 5,758 cases of TB in the UK in 2015 and 39% of them in London. This has dropped from a peak of 8,919 cases in 2011. Left untreated, TB is life-threatening, but is usually curable with antibiotics. The sooner the illness is diagnosed and treated, the better, both in terms of the individual’s health and in preventing them from passing it on to others. 

What’s new 
In January, NICE published new quality standards on TB, looking at prevention, identification and managing the infection in children, young people and adults. Standards include: Testing those aged 16-35, upon registration with a GP, if in the past five years they have arrived in the UK from countries with a high incidence of TB, and offering accomodation to homeless people with active TB for the duration of their treatment.

TB symptoms can be vague and similar to those of other illnesses. The most common are a cough for three weeks or longer, breathlessness, extreme tiredness, fever, night sweats, loss of appetite, and weight loss.   

Causes/risk factors 
The disease is spread through prolonged contact with the coughs and sneezes of those who have an active TB infection in their lungs. In 2015, almost three-quarters of cases were found among those born outside the UK. TB is also associated with health inequality: those living in deprived communities having rates seven times higher than those in the least deprived areas. Rates are high in those who are homeless and who have an increased risk of delays in diagnosis, drug resistance, onward transmission and poor treatment outcomes. Others more at risk include those with a condition that weakens their immune system, such as HIV, the very young and very old, and those in poor health through lifestyle, such as drug or alcohol misuse. 

How you can help your patient 
Nurses play a vital role in educating patients about TB, providing information in easily digestible formats to improve understanding. Building trusting relationships with patients can be highly effective in persuading them to follow and complete their treatment. Working together with case or link professionals can also help to allay patients’ worries.  

Expert comment 
Christine Bell, lead nurse for TB at Central Manchester University Hospitals Foundation Trust:

‘Anything that has TB in the title is welcome, because it is highlighting something that has been largely ignored for many years. There is much more emphasis on prevention now, and this is reflected in these standards. 

‘There can be a stigma about having TB and we need to demystify those things that make people wary of it. As it is not seen or talked about much, this fuels the misconceptions – for example, that it’s highly contagious. TB is a small, distinct speciality, and unless you are working regularly with patients who have it, your knowledge can be patchy or out of date. But there will be someone in your area who specialises in TB, so it’s worth making contact with them for the latest guidance.’  

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