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Biomedical subjects

L P Ormerod

Publications and source records attributed to L P Ormerod.

At least 19 recordsLinked to original sources
PubMed2005

A case control study in the Indian subcontinent ethnic population on the effect of return visits and the subsequent development of tuberculosis.

SETTING: A local government area in North West England with a significant population of Indian subcontinent (ISC) ethnic origin and a high incidence of tuberculosis. OBJECTIVE: To assess whether return visits to the ISC are associated with an increased risk of developing clinical tuberculosis. METHODS: Analysis of data prospectively obtained from ISC patients diagnosed with TB in 1998-2002 (cases) and age and sex matched ISC patients in two local GP practices (controls). RESULTS: There is at best weak evidence of association between case status and whether individuals have had a repeat visit to the subcontinent within 3 years of notification in this cohort; odds ratio 1.26 (95% CI (0.95, 1.76)); Fishers exact test P=0.09.

Adult↗
PubMed2005

Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment.

Multidrug-resistant tuberculosis (MDR-TB) is an increasing global problem, with most cases arising from a mixture of physician error and patient non-compliance during treatment of susceptible TB. The extent and burden of MDR-TB varies significantly from country to country and region to region. As with TB itself, the overwhelming burden of MDR-TB is in high-burden resource-poor countries. The diagnosis depends on confirming the drug susceptibility pattern of isolated organisms, which is often only possible in resource-rich settings. There should be a strong suspicion of drug resistance, including MDR-TB, in persons with a history of prior treatment or in treatment failure cases. Treatment in developed countries is expensive and involves an individualized regimen based on drug susceptibility data and use of reserve drugs. In resource-poor settings a WHO retreatment regimen may be used, but increasingly the move is to a directly observed treatment based 'DOTS-plus' regimen in a supported national TB programme. However, even where such treatment is given, the outcome for patients is significantly worse than that for fully susceptible TB and has a much higher cost.

Antibiotics, Antitubercular↗
PubMed2004

Outcome for adult contacts of smear-positive pulmonary tuberculosis in the absence of X-ray follow-up: 2000-03.

The effects of the policy change in X-ray follow-up of adult tuberculin-positive close contacts of sputum microscopy positive pulmonary tuberculosis made by the Joint Tuberculosis Committee of the British Thoracic Society in 2000 were monitored prospectively from late 2000 until the end of 2003. No cases in contacts that could have been detected by interval X-rays at three and 12 months were found. The data, on 291 cases, support the abandonment of X-ray follow-up in favour of an 'inform and advise' strategy after an initial normal chest X-ray in this category of tuberculosis contact.

Adolescent↗
PubMed2004

Effect of Mycobacterium vaccae (SRL172) immunotherapy on radiographic healing in tuberculosis.

OBJECTIVE: Controlled trials have failed to show an effect of Mycobacterium vaccae immunotherapy on treatment outcome and mortality in patients with tuberculosis (TB); however, several studies have suggested improvement in radiographic clearing and resolution of cavitary disease. METHODS: To assess the effect of M. vaccae immunotherapy on radiographic healing in pulmonary TB, chest X-rays from three randomized placebo-controlled trials of M. vaccae given as a single injection during the first 2 weeks of treatment were interpreted by a single, masked assessor using a standard scheme. Endpoints were the overall degree of radiographic improvement or deterioration and changes in cavitary disease at the end of antituberculosis treatment and follow-up. RESULTS: Of 1018 patients (478 HIV-infected; 540 HIV-uninfected) with an end of treatment or end of follow-up X-ray analyzed, 496 received M. vaccae and 522 received placebo. There was no difference in radiographic improvement or deterioration or cavitary disease at the end of treatment or follow-up comparing the M. vaccae and placebo groups. Results were similar comparing HIV-infected and HIV-uninfected patients. CONCLUSION: Adjunctive immunotherapy of drug-susceptible pulmonary TB with M. vaccae during the first 2 weeks of treatment did not improve radiographic responses to treatment or resolution of cavitary disease.

Adult↗
PubMed2003

A decade of change: tuberculosis in England and Wales 1988-98.

Tuberculosis cases in children (aged under 15 years) in the National Surveys rose from 308 (rate: 3.3 per 100,000) in 1988 to 408 (4.2 per 100,000) in 1993 and then fell to 364 (3.6 per 100,000) in 1998. The rates in white children were 1.6, 2.0, and 1.1 per 100,000 respectively; in Indian subcontinent children, the rates were unchanged between 1988 and 1993 at around 33 per 100,000 but fell to 23 per 100,000 in 1998. In black African children, the rates were 15, 34, and 71 per 100,000 respectively. From 1988 to 1998, the proportion of cases resident in London more than doubled to 49% (rate: 11.9 per 100,000) and the proportion of cases in children born abroad increased from 13% to 27% in the country as a whole. Although the overall rate of tuberculosis in children in England and Wales has changed little between 1988 and 1998, the distribution of disease has changed in line with the change in adults. Services for the diagnosis and treatment of tuberculosis in children should be adapted to the changing pattern of disease in this group. Continuous enhanced tuberculosis surveillance will enable more detailed and timely scrutiny of trends in tuberculosis in the future.

Adolescent↗
PubMed2002

Outcome of the treatment of culture negative tuberculosis (respiratory and non-respiratory): Blackburn 1996-2000.

OBJECTIVE: To determine the outcome of treating patients without culture confirmation of tuberculosis, with a regimen of two months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by four months of isoniazid and rifampicin (2HRZE/4HR) in a setting with a rate of isoniazid resistance of 7.5% in culture confirmed cases. SETTING: Tuberculosis patients treated in the Blackburn, Hyndburn and Ribble Valley districts of the UK between 1996 and 2000 inclusive. METHODS: Patients from a detailed prospective clinical and epidemiological data base for all tuberculosis patients were studied for the years 1996-2000. RESULTS: One hundred and fourteen cases, all but two of Indian subcontinent ethnic origin, without culture confirmation had received 2HRZE/4HR. Twenty had pulmonary, 55 other respiratory and 39 non-respiratory tuberculosis. There was no bacteriologically confirmed relapse, 1 case was retreated as a clinical relapse. CONCLUSION: The treatment of tuberculosis cases without culture confirmation with a regimen of 2HRZE/4HR gives highly acceptable results. The clinical relapse rate was 0.85% (1/114), and the cure rate 99.15%.

Antitubercular Agents↗
PubMed2002

Tuberculosis treatment outcome monitoring: Blackburn 1988-2000.

SETTING: All cases of tuberculosis in a high prevalence district (population 269,000) of England. OBJECTIVE: To analyse the tuberculosis programme outcome for confirmed pulmonary tuberculosis, and all other categories of cases for 1988-2000 inclusive. DESIGN: The outcome of all cases treated during the period 1988-2000 inclusive was assessed by agreed European outcome criteria, retrospectively for 1988-1998 and prospectively for 1999-2000. RESULTS: A total of 729 tuberculosis cases were notified, with 209 definite (culture-positive) pulmonary cases. Of the 205 definite pulmonary cases treated in life, 182 received self-administered treatment (SAT) and 23 directly observed treatment (DOT), with an 88% cure/completion rate and a 12% death rate. The relapse rate for SAT was 1/182 (0.5%) and 1/23 for DOT (4.3%). The cure/completion rate for all patients together was 94.3%, with a relapse rate of 0.8%. CONCLUSION: In this resource-rich setting, treatment largely by SAT, but carefully monitored, gives a very high cure/completion rate. Universal rather than selective DOT would make little additional impact on patient outcome. These outcomes are not likely to be reproducible, however, with SAT in a resource-poor setting.

Adult↗
PubMed2002

Serial surveys of the tuberculosis nursing and support provision in the high incidence districts of England and Wales.

Postal surveys were carried out in 1998 and 2001 in the 43 high incidence TB districts of England and Wales (defined as an incidence of 15/100,000 per annum or greater). The provision of TB nursing and support staff was then compared with that recommended by the Joint Tuberculosis Committee for the numbers of TB notifications in 1997 and 2000 in the same areas. Forty-two districts replied in 1998, and all 43 replied in 2001. In 1998 only six out of the 22 high incidence areas outside Greater London met the minimum criteria for both nursing and clerical provision; none in Greater London did so. In 2001 only five out of 22 high incidence areas outside and one out of 21 inside Greater London met both criteria. The provision of nursing and clerical support for tuberculosis falls below minimum criteria in a substantial majority of high incidence areas and is not improving. Unless addressed, continuing under-provision of resources could itself contribute to a further rise in cases of tuberculosis.

Disease Notification↗
PubMed2002

Assessment of the impact of BCG vaccination on tuberculosis incidence in south Asian adult immigrants.

Although BCG vaccination is recommended for tuberculin negative adult immigrants, there has hitherto been no evidence of its efficacy in this group. This epidemiological study compares the incidence of tuberculosis in a cohort of South Asian adult immigrants vaccinated on entry to the UK with its incidence in cohorts of immigrants of the same age and origin estimated from the five-yearly national surveys. Results suggest that BCG vaccine may have reduced the incidence of tuberculosis by up to 87.6% (95% confidence interval 55.2% to 98.5%) and support the current recommendation to vaccinate this high-risk group.

Adolescent↗
PubMed2001

Can a nine-month regimen be used to treat isoniazid resistant tuberculosis diagnosed after standard treatment is started?

OBJECTIVES: National tuberculosis treatment guidelines suggest a regimen of 2RZE/10RE for the treatment of isoniazid resistant organisms. A retrospective clinical study of all patients treated for non-MDR-TB isoniazid-resistant organisms was undertaken. METHODS: A continuous database of the patients treated between 1978-1999 inclusive was examined to determine the regimens used and the outcome of treatment for such patients. RESULTS: Thirty-seven patients were identified. Eighteen had regimens of greater than 9 months, 19 had regimens of 9 months or less. No relapses occurred in those cases treated with a regimen of 2RZE/7RE during 12 months' minimum follow-up. CONCLUSIONS: A regimen of 2RZE/7RE may be possible for the treatment of isoniazid-resistant organisms if given either under close supervision or as a formally supervised regimen. Larger clinical studies or a controlled clinical trial are needed to confirm these initial findings.

Adult↗
PubMed2001

Are there still effects on Indian Subcontinent ethnic tuberculosis of return visits?: a longitudinal study 1978-97.

OBJECTIVE: To assess whether return visits to the Indian Subcontinent (ISC) are associated with increased risks of developing clinical tuberculosis. METHODS: Descriptive analysis of epidemiological records over a period of 1978-97 inclusive in Blackburn, Hyndburn and Ribble Valley for individuals of ISC ethnic origin notified with tuberculosis. Those cases diagnosed through local contact tracing exercises were excluded. RESULTS: Of 1032 eligible individuals notified with tuberculosis, 228 (22.1%) reported prior visits to the ISC. Of these 151 (66%) reported having visits within 3 years of that notification, including 60% of the United Kingdom (U.K.) born without prior exposure to the ISC. CONCLUSION: The clinical observations are consistent with the hypothesis that return visits to the ISC carry a risk of acquiring tuberculosis. This cannot be confirmed, however, without information about the return visits in the ISC population as a whole. A case-control study may be required to confirm the hypothesis.

Adult↗
PubMed2001

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998.

BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.

AIDS-Related Opportunistic Infections↗
PubMed2001

Drug resistance trends in M. tuberculosis: Blackburn 1990-1999.

SETTING: Blackburn, United Kingdom. OBJECTIVE: To describe the drug resistance data for Mycobacterium tuberculosis in white and Indian Subcontinent (ISC) ethnic patients in a high prevalence district in the United Kingdom (UK) over a 10-year period. DESIGN: Data from a detailed prospective clinical and epidemiological database of all notified patients were examined for the years 1990-1999 inclusive. RESULTS: Primary isoniazid resistance was found in 17/229 (7.4%) of ISC and 3/67 (4.5%) of white isolates. There was no statistical difference in the rates of drug resistance in those of ISC ethnic origin, whether they were ISC or UK born and whether or not they had made return visits to the ISC. CONCLUSION: The rate of primary isoniazid resistance remains between 5-10% in ISC patients in Blackburn, showing no fall from previous surveys. The rate of drug resistance was not lower in those born in the UK, irrespective of whether return visits had been made to the ISC. These data will need to be further monitored.

Antitubercular Agents↗
PubMed2000

Mammary tuberculosis: rare but still present in the United Kingdom.

Mammary tuberculosis (TB) is rare and usually affects women from the Indian sub-continent and Africa. It may be mistaken clinically for carcinoma or pyogenic abscess. Tuberculosis (particularly drug-resistant TB) is on the increase in areas of the UK with rising numbers of immigrants, some of whom may present with breast lesions of uncertain aetiology. Between 1978 and 1997 there were 436 cases of TB notified for Indian Sub-continent females aged 15-49 years in Blackburn, Hyndburn and Ribble Valley, Lancashire, UK. Ten cases were mammary TB (10/436 = 2.3%) which was clinically suspected in only three patients preoperatively, despite the area having large numbers of immigrants. Mammary TB should be included in the differential diagnosis of breast lesions in women from those ethnic groups at increased risk of TB. Pus and/or breast tissue samples should be subjected to TB culture and histological examination for both diagnosis of TB and determination of drug sensitivities.

Abscess↗