Diagnosis of human bovine tuberculosis aided by PET/CT scanning and EBUS-TBNA.

Human bovine tuberculosis is a rare zoonotic infection in developed countries which has been achieved predominantly by effective eradication programmes in cattle. The principal modes of transmission are consumption of unpasteurised dairy products and close contact with infected cattle. The clinical and radiological presentation is indistinguishable from tuberculosis caused by Mycobacterium tuberculosis The diagnosis should be considered in individuals with relevant risk factors who present with intra/extrathoracic pathology. We describe and discuss a case of bovine tuberculosis with a synchronous primary bronchus carcinoma in an immunocompetent individual who presented with a solitary pulmonary nodule and contralateral mediastinal lymphadenopathy on CT imaging. The diagnosis of M. bovis infectionwas aided by 18F-fluorodeoxyglucose positron emission tomography/CT imaging and endobronchial ultrasound-guided mediastinal lymph node sampling.

Improving the uptake of HIV testing in patients with tuberculosis.

The HIV epidemic has increased the global tuberculosis (TB) burden and focused attention on the need to strengthen links between TB and HIV programmes in order to tackle these public health issues more effectively (World Health Organization (WHO), 2004). HIV testing is now recommended in various healthcare settings and guidelines state that it should include all patients with a diagnosis of active TB (British HIV Association, British Association of Sexual Health and HIV, British Infection Society, 2008; Health Protection Agency (HPA), 2009). This has been shown to standardise HIV testing and improve outcomes as HIV infection will affect the management of active TB and will reduce transmission of the virus within the community (HPA, 2009). The purpose of this study was to determine if a change had occurred after the introduction of nurse-led HIV testing following the results of an audit. The re-audit examined whether a change had occurred in the rate of HIV testing in confirmed active TB cases. The study covered a 12-month period; 31 cases of active TB were identified for inclusion in the study. Patients were offered testing in 90.3% of cases and the results strongly demonstrated that nurse-led HIV testing can improve uptake in both a clinic and community setting.

Latent tuberculosis: concordance and duration of treatment regimens.

Over the past century, the UK has made significant progress in combating tuberculosis (TB) through improved health care and better preventative measures. However, it has now been identified as a new threat that needs concerted action. An important component in dealing with this threat is identifying and treating people with latent infection. This will prevent active disease and thwart the spread of tuberculosis infection. The aim of the study was to determine whether treatment concordance was affected by length of treatment regimen in the UK and to identify factors that may impact upon treatment completion. The audit was spread over a two-year period and looked at all patients on treatment for latent infection using the UK recommended regimens of either three months of dual therapy or six months using monotherapy. The results indicated that the 3-month regime had not improved concordance, as expected, with a slightly better completion rate in the 6-month group. However, the study did highlight a 'lost-to-follow-up' group of patients, who failed to present themselves following presumed completion.