REMEDY : BNSSG referral pathways

Tuberculosis

Checked: 18-10-2018 by vicky.ryan Next Review: 18-10-2019

Principles of Management

The following advice has been developed by local TB specialists.

  • If your patient has symptoms of active TB ( cough for longer than 3 weeks, sweats and weight loss) please start sputum collection for TB and refer urgently to the TB clinic.

  • Avoid clarithromycin if active TB being considered as it has anti-tuberculous activity.

  • 3A positive IGRA (interferon gamma release assay) does not distinguish between latent and active TB.

  • A negative IGRA does not rule out active TB and active/ latent TB in children – always need to inform and advise on the symptoms of TB.

  • If your patient has latent TB infection and young children, consider referring them to the Children’s Hospital for screening for latent TB infection.

  • Replace Vitamin D in patients with latent and active TB, as deficiency can predispose to TB reactivation.

  • Remember extra-pulmonary TB in patients from high risk groups, especially spinal TB in patients with persistent back pain, and patients with persistent neck lumps.  Recommend a low threshold for referral to the TB clinic.

Tuberculosis is a notifiable disease and if suspected then PHE should be informed. Do not wait for confirmation of diagnosis.

Referral Guidance

Please see the following documents for information about referral criteria and guidelines.

Suspected TB  - the TB clinics at UHB and NBT (at NBT patients are seen in the Lung infection clinic) are now available via eRS as a RAS service. Referrals should be marked urgent and patients will be seen as soon as possible.

See Referral of suspected TB (Pathway 1) 2018  .

Please also note the following:

  • Exclusions - patients who are HIV positive should be referred to the infectious diseases consultants at North Bristol Trust.
  • If active pulmonary TB is suspected please arrange chest X ray and 3 sputum samples to be sent for acid fast bacilli and TB culture.
  • Please contact the TB nurses on 0117 9543066 or e-mail them on bristoltbnurse@nhs.net if you require further information prior to the referral. 

 

Screening and immunisation

TB screening in primary care (Pathway 2) 2018

TB screening for new entrants aged 0 - 16 (Pathway 3) 2018

BCG immunisation in children

 

TB Nurse Service - Bristol Community Health

The team are responsible for providing outreach and support to people with active or latent tuberculosis (TB) in Bristol and South Gloucestershire. The team are responsible for identifying and arranging screening for people who’ve been exposed to TB.

What is the service?

  • The service supports patients to complete treatment for tuberculosis

  • Promoting community and professional awareness of TB, and supporting people through the process of diagnosis

  • The team works closely with the TB medical teams at Bristol Royal Infirmary and Southmead Hospital

Who is this service for?

  • The service is for people who are undergoing treatment or investigations for tuberculosis

  • It is for professionals and organisations requiring information about TB

  • People who are referred to the service by the hospital doctor who has diagnosed TB or suspected TB, or who is investigating the person for possible TB

  • GPs/Primary Care staff wishing to discuss management of a case or suspected case

Please visit the Bristol Community Health - Tuberculosis Nurse Service website for further information and referral forms.

Red Flags

Consider urgent admission for patients with suspected CNS TB, neurological symptoms, or those who are systemically unwell.