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EDITORIALS: James J C Lewis and Violet N Chihota Increasing drug resistant tuberculosis in the UK BMJ 2008; 0: bmj.39560.630613.80v1 [Full text]

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Re: Increasing drug resistant tuberculosis in the UK

Subhash C. Arya, Nirmala Agarwal   (22 May 2008)

The multi-drug resistant tuberculosis service

Peter D.O. Davies, Damian Cullen   (4 June 2008)

Re: Increasing drug resistant tuberculosis in the UK 22 May 2008
Subhash C. Arya, Clinical Microbiologist Delhi, 110048, India, Nirmala Agarwal Send response to journal: Re: Re: Increasing drug resistant tuberculosis in the UK	To the Editor Exclusion of genital spread and morbidity of tuberculosis in your editorial on increasing drug resistant tuberculosis in the UK1 is rather baffling. For a global approach, genital tuberculosis could not be left unattended. The treatment of female genital tract tuberculosis was unsatisfactory before 1950s till effective chemotherapeutics were offered. During the 1970s, the possible tuberculosis transmission through sexual intercourse of male genitourinary tuberculosis was speculated2. In the post-chemotherapy phase, genital tuberculosis has been prevalent globally. In 25 women in Mexico the genital tuberculosis presentation was of infertility, 21 cases, uterine hemorrhage, 3 and acute abdomen, one case3. Recently, a case of culture-positive primary cutaneous Mycobacterium tuberculosis infection of the penis was diagnosed in a male patient who had been domiciled in the United Kingdom for more than four decades. After one year, endometrial tuberculosis was diagnosed in his wife. Both organisms were confirmed to be indistinguishable by use of molecular techniques4. M. tuberculosis in a 66-year-old Japanese patient caused endometrial tuberculosis with positive endometrial culture, endometrial epitheloid cell granuma5. Any comprehensive worldwide plan to face tuberculosis head on would be fortified by involvement of professionals handling cases with sterility/infertily: tuberculosis anywhere is tuberculosis every where1. Fiscal input to deal with connection of genital tract along with pulmonary or extra-pulmonary tuberculosis should be cost effective. The precise contribution through genital tuberculosis towards oligoasthenospermia, and endometrial tuberculosis, tubercular salpangitis associated with infertility 3, 4 remains to be determined. Simultaneous investigations on both the partners would pick up M.tuberculosis positive partners, where condoms would be essential to prevent any homo- or heterosexual spread. References 1. Lewis JJC, Chihota VN. Increasing drug resistant tuberculosis in the UK. BMJ, doi:10.1136/bmj.39560.630613.80 (published 1 May 2008) 2. Sutherland AM. Gynaecological tuberculosis, past, present and future. Arch Gynakol. 1975 ;218(4):261-8 3. Figueroa-Damian R, Martinez-Velazco I, Villagrana-Zesati R, Arredondo- Garcia JL. Tuberculosis of the female reproductive tract: effect on function. Int J Fertil Menopausal Stud. 1996 ;41(4):430-6 4. Angus BJ, Yates M, Conlon C, Byren I. Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing. Clin Infect Dis. 2001;33(11):E132-4. Epub 2001 Oct 22. 5. Taniguchi H, Izumi S. [Case of endometrial tuberculosis]. Kekkaku. 2005 ;80 Competing interests: None declared
The multi-drug resistant tuberculosis service 4 June 2008
Peter D.O. Davies, Consultant Physician Cardiothoracic Centre, Liverpool, L14 3PE, Damian Cullen Send response to journal: Re: The multi-drug resistant tuberculosis service	So far the UK seems to be keeping clear of most of the international increase in drug resistant tuberculosis, in particular multi-drug resistant tuberculosis (MDRTB)1. But how long can this be maintained 2? The problem with drug resistant tuberculosis is that it is still relatively uncommon but gradually increasing. Individual clinicians will have very little experience in managing cases. To help this situation, the MDRTB Service has been established at the Cardiothoracic Centre in Liverpool and has been operational since 1st January 2008. The Service has the support of the relevant professional bodies, including the British Thoracic Society, the British Infection Society and the Health Protection Agency. Essentially it is an electronically linked instant reaction expert group, who can give advice and direct management of cases across the country. Indeed it has already done so in some seventeen cases from across the UK. By assisting clinicians in the management of cases of drug resistant TB the national MDRTB service offers our best hope in overcoming the increasing problem of drug resistance until new drugs become available. The Baltic states have operated a similar system for some years with good success in reducing their cases. The second function of the Service is to collect data on all MDRTB cases identified in the UK with a view to developing a consensus on the most effective methods of treatment in the emerging field of MDRTB. The data collection will also help assess outcomes of MDRTB patients. The Service can be contacted either by email: MDRTBservice@ctc.nhs.uk or by phone: 0151 600 1427 . References. 1. Kruijshaar ME, Watson JM, Drobniewski F, et al. Increasing antituberculosis drug resistance in the United Kingdom: analysis of national survey data. Brit Med J 2008; 336:1231-1234. 2. The rise and spread of drug resistant tuberculosis (News item) Lancet 2008;371:698. Competing interests: None declared