Bacteriological status of notified tuberculosis cases in the Republic of Ireland 1982-85

Tuberculosis in the west of Ireland 1986-1990

A review of mycobacteria isolated from clinical samples from the Western Health Board Area (WHBA) for the years 1986 to 1990 was performed to establish the pattern of mycobacterial infection. The incidence of microbiologically proven cases of tuberculosis (13.3/100,000) and of sputum smear positive cases (6.2/100,000) was determined and correlated with notification data. M. bovis accounts for 6.3% of cases of microbiologically confirmed tuberculosis in this area. Resistance to one or more of the first line anti-tuberculous drugs was noted in 5.3% of isolates (excluding pyrazinamide resistance in M. bovis). Clinically significant isolates of mycobacteria other than tuberculosis (MOTT) were rare throughout the five year period. The overall incidence of microbiologically proven cases of tuberculosis is relatively high and M. bovis and drug resistant isolates of M. tuberculosis are relatively common.

Endometrial and pulmonary sarcoidosis

A 33 year old woman with irregular menses due to endometrial sarcoidosis and a family history of sarcoidosis is described. Its relative increase in importance in the wake of the decline in the incidence of genital tract tuberculosis in Ireland is discussed.

A school microepidemic of tuberculosis

BACKGROUND

Microepidemics of tuberculosis continue to occur in countries with a low incidence of tuberculosis.

METHODS AND RESULTS

A microepidemic of tuberculosis in a secondary school with 604 girls in Cork city, Ireland, in 1986 with follow up to 1990 is described. Neonatal BCG vaccination was discontinued in the city in December 1972 so most of the 342 pupils who had received BCG were aged 14 years or more. Six active cases and 75 tuberculin positive cases were found. Four of the six girls with active disease had had neonatal BCG. The 75 pupils with a positive (grade 3 or 4) Heaf test response were given chemoprophylaxis with rifampicin and isoniazid for six months; none had developed active tuberculosis four years later. The brother of the girl who was the probable index case, however, developed active tuberculosis in 1988 despite similar chemoprophylaxis.

CONCLUSION

The episode highlights the fact that children who have had neonatal BCG can develop active tuberculosis as teenagers.