Trends in tuberculosis

What gets measured gets done: an assessment of local data uses and needs in large urban health departments

CONTEXT

The epidemiologic shift in the leading causes of mortality from infectious disease to chronic disease has created significant challenges for public health surveillance at the local level.

OBJECTIVE

We describe how the largest US city health departments identify and use data to inform their work and we identify the data and information that local public health leaders have specified as being necessary to help better address specific problems in their communities.

DESIGN

We used a mixed-methods design that included key informant interviews, as well as a smaller embedded survey to quantify organizational characteristics related to data capacity. Interview data were independently coded and analyzed for major themes around data needs, barriers, and achievements.

PARTICIPANTS

Forty-five public health leaders from each of 3 specific positions-local health official, chief of policy, and chief science or medical officer-in 16 large urban health departments.

RESULTS

Public health leaders in large urban local health departments reported that timely data and data on chronic disease that are available at smaller geographical units are difficult to obtain without additional resources. Despite departments' successes in creating ad hoc sources of local data to effect policy change, all participants described the need for more timely data that could be geocoded at a neighborhood or census tract level to more effectively target their resources. Electronic health records, claims data, and hospital discharge data were identified as sources of data that could be used to augment the data currently available to local public health leaders.

CONCLUSIONS

Monitoring the status of community health indicators and using the information to identify priority issues are core functions of all public health departments. Public health professionals must have access to timely "hyperlocal" data to detect trends, allocate resources to areas of greatest priority, and measure the effectiveness of interventions. Although innovations in the largest local health departments in large urban areas have established some methods to obtain local data on chronic disease, leaders recognize that there is an urgent need for more timely and more geographically specific data at the neighborhood or census tract level to efficiently and effectively address the most pressing problems in public health.

Paradoxical tuberculomas after completion of antituberculous treatment

Paradoxical reactions in tuberculosis have been reported in patients with tuberculous meningitis and appear as intracranial tuberculomas within 14-270 days of starting antituberculous therapy (ATT). Paradoxical reactions are due to the immune response of the host to ATT. They are commonly seen in the intensive phase of chemotherapy. However, paradoxical reactions occurring after completion of ATT are rare. We report 2 patients with tuberculous meningitis who had already completed ATT and then developed tuberculomas.

Paradoxical tuberculomas after completion of antituberculous treatment

Paradoxical reactions in tuberculosis have been reported in patients with tuberculous meningitis and appear as intracranial tuberculomas within 14-270 days of starting antituberculous therapy (ATT). Paradoxical reactions are due to the immune response of the host to ATT. They are commonly seen in the intensive phase of chemotherapy. However, paradoxical reactions occurring after completion of ATT are rare. We report 2 patients with tuberculous meningitis who had already completed ATT and then developed tuberculomas.

Mycobacterium tuberculosis: a continuing cause of sudden and unexpected death in west London

AIMS

To describe the pathological and background features of several cases of tuberculosis diagnosed at post mortem examinations and performed on behalf of HM Coroner over a three year period in west London.

METHODS

Postmortem examinations were carried out by two pathologists working at hospital and public mortuaries in west London. Cases of tuberculosis were provisionally diagnosed on gross examination and the diagnosis confirmed on haematoxylin and eosin and Ziehl-Neelsen staining of retained tissues. The background information was obtained by scrutinising hospital records and by direct enquiry to general practitioners by coroners' officers.

RESULTS

Thirteen cases of pulmonary tuberculosis were diagnosed during the period. No other cause of death was found. The incidence of fatal pulmonary tuberculosis was 0.28% of coroners' necropsies in the study region. Cases had been referred to the coroner because death had occurred unexpectedly, or because no recent medical attention had been sought. Most cases arose among the elderly Asian immigrant population or the homeless or the alcoholic, or both. In 10 cases the macroscopic findings strongly indicated pulmonary tuberculosis and in the other three the diagnosis was considered to be a differential diagnosis.

CONCLUSIONS

These findings have important health implications for those carrying out post mortem examinations from these groups as well as for those involved with the continuing care of immigrant or vagrant populations.

Patterns of calcifications and cholangiographic findings in hepatobiliary tuberculosis

The radiologic findings on conventional examinations (plain films and cholangiograms) in a large group of patients with proven hepatobiliary tuberculosis are reviewed. The plain film findings of large "chalky" and confluent hepatic calcifications or nodal-type calcifications along the course of the common bile duct are suggestive of hepatobiliary tuberculosis. Small, discrete, scattered calcifications may be mimicked by histoplasmosis but can be differentiated from hepatobiliary tuberculosis. Obstructing defects seen on cholangiography are indicative of tuberculosis when adjacent calcifications are present. The patterns of liver calcifications could provide a clue to the diagnosis of hepatobiliary tuberculosis and its differentiation from liver calcifications of various other etiologies.