Intended for healthcare professionals



BMJ 2003; 327 doi: (Published 11 September 2003) Cite this as: BMJ 2003;327:630

Around eight million new cases of tuberculosis were found worldwide in 2000, and the current rate of increase is 1.7% each year. Nearly half of people with a new diagnosis had positive findings on examination of their sputum and so were highly infectious (Annals of Medicine 2003; 35: 235-43). Part of the recent rise in numbers is due to rapid population growth in Africa and Asia, but two other factors—HIV infection and malnutrition—are remediable to some extent. The review also includes one warning: “doctors who cannot treat TB properly should not treat TB at all.”

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An 84 year old man presented with a six month history of a pruritic rash. It had been treated as eczema with topical steroids, but got worse. His wife had also developed pruritis. Examination showed large areas of confluent white scale on his penis, scrotum, and buttocks. Volar aspects of the wrists contained multiple serpiginous scaling lesions. The rest of his body was covered with erythematous papules. We diagnosed Norwegian scabies and treated him with three cycles of topical 5% permethrin. Three weeks later the scaling had resolved, leaving residual hyperpigmentation. Norwegian scabies occurs predominantly in elderly, infirm, or immunosuppressed people and in those with mental illness. It occurs often in the genital area.

E Ladoyanni, specialist regisrar, S …

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