When students become patients: TB disease among medical undergraduates in Cape Town, South Africa.

BACKGROUND: Medical students acquire latent tuberculosis (TB) infection at a rate of 23 cases/100 person-years. The frequency and impact of occupational TB disease in this population are unknown. METHODS: A self-administered questionnaire was distributed via email and social media to current medical students and recently graduated doctors (2010 - 2015) at two medical schools in Cape Town. Individuals who had developed TB disease as undergraduate students were eligible to participate. Quantitative and qualitative data collected from the questionnaire and semi-structured interviews were analysed with descriptive statistics and a framework approach to identify emerging themes. RESULTS: Twelve individuals (10 female) reported a diagnosis of TB: pulmonary TB (n=6), pleural TB (n=3), TB lymphadenitis (n=2) and TB spine (n=1); 2/12 (17%) had drug-resistant disease (DR-TB). Mean diagnostic delay post consultation was 8.1 weeks, with only 42% of initial diagnoses being correct. Most consulted private healthcare providers (general practitioners (n=7); pulmonologists (n=4)), and nine underwent invasive procedures (bronchoscopy, pleural fluid aspiration and tissue biopsy). Substantial healthcare costs were incurred (mean ZAR25 000 for drug-sensitive TB, up to  ZAR104 000 for DR-TB). Students struggled to obtain treatment, incurred high transport costs and missed academic time. Students with DR-TB interrupted their studies and experienced severe side-effects (hepatotoxicity, depression and permanent ototoxicity). Most participants cited poor TB infection-control practices at their training hospitals as a major risk factor for occupational TB. CONCLUSIONS: Undergraduate medical students in Cape Town are at high risk of occupationally acquired TB, with an unmet need for comprehensive occupational health services and support.

[Health care channels for new cases of respiratory tuberculosis in Seine Saint-Denis in 1984-1986]. / Les filières de soins des nouveaux cas de tuberculose respiratoire en Seine Saint-Denis en 1984-1986.

The purpose of this study was to observe routine practice in the care of tuberculosis cases treated in the Seine Saint-Denis department in 1984, with reference to the recent recommendations of the French Pneumology Society. The pathway of each patient through the care network was established for 336 adult cases being treated for respiratory tuberculosis for the first time. The social and economic cost of each pathway was evaluated. The results show the multiplicity of health services intervening in the care of these patients, the persistence of hospitalization, sanatorium care, and long sick-leaves from work, together with major differences in the care pathways according to the nationality, sex, and socio-economic group of the patients. The cost of tuberculosis treatment is shown to be high for both patients and the community.