Tuberculosis in an area bordering East London : Significant local variations when compared to national data

From September 1996 to June 1997, in an area bordering East London, we prospectively collected epidemiological, clinical and microbiological data on all patients with newly diagnosed culture-positive tuberculosis and compared these to national data based on notifications. The significant differences were that tuberculosis was diagnosed almost exclusively in non-Caucasian patients (42/47 [89%]) and that there was a high percentage of extrapulmonary tuberculosis (27/47 [57%]) including four cases of tuberculous meningitis and five cases of osteomyelitis. We also observed that 19/27 (70%) of patients with extrapulmonary tuberculosis had normal chest X-rays, 3/17 (18%) sub-Saharan Africans were HIV antibody-positive and drug resistance strains were isolated from six sub-Saharan Africans and one Caucasian. Figures for treatment failures and mortality compared favorably to national averages at 6 months. National data do not accurately reflect local epidemiology and clinical presentations. Hospital-based surveillance and promoting awareness of local differences is essential to prevent delayed diagnosis, inappropriate management and poor clinical outcome.