TB News

A HUGE thank you to Mithun Deb (Systems Specialist, Whittington Health) for his skill and patience in developing a bespoke Clinical Noting template in the Electronic Patient Record (Medway) with Dr Helen Booth (Clinical lead, SHUB/UCLH) . Thanks to Lusha Kellgren (TB Specialist Nurse SHUB) who did much of the user testing. At the NCL TB Service South Hub@Whittington aka the SHUB.

 

In May, Maddy Wickers (TB Outreach Worker, pictured front row far left) played in the REAL North London football derby of Whittington Hospital vs North Middlesex Hospital at the Tottenham Hotspur Stadium.

 

Daniel Levy, Chairman, Tottenham Hotspur, said: “The staff at our local hospitals are true heroes who we owe a great deal to and the Club and AIA are honoured to provide this special opportunity as a ‘thank you’ for their hard work throughout the pandemic.

 

The score: North Middlesex 4, Whittington Hospital 3

Abbie Izzard (TB Clinical Support Worker) published that patients referred to the Social Care Team (SCT) were significantly more likely to complete treatment for TB than those who were not (88.2% versus 77.7% respectively) Improved treatment completion for tuberculosis patients: The case for a dedicated social care team - PubMed (nih.gov)

 

It is great that the positive role of the TB SCT/Link worker(s) continues to be demonstrated. Two NCL collaborators, involved in the original TB Link project Establishing a new service role in tuberculosis care: the tuberculosis link worker - Craig - 2008 - Journal of Advanced Nursing - Wiley Online Library ,which led to the SCT being embedded into the NCL TB service, have received further recognition of their work:

Many of our team have been involved in COVID related research but TB research is still active in NCL and include:

Investigating the immune mechanisms that influence TB outcomes so that preventative measures can be targeted at those at highest risk of active disease

https://www.ucl.ac.uk/infection-immunity/sites/infection_immunity/files/1707-hirv-tb-study_protocol-v2-14-09-2018.pdf
PI: Professor Mahdad Noursadeghi (SHUB/UCL)

Looking at how to support people through TB treatment

PI Professor Marc Lipman (RFH/UCL)

A randomised controlled trial to evaluate the effectiveness of using the RD-1 based C-Tb skin test as a replacement for blood-based interferon-? release assay for detection of latent TB infection and initiation of TB preventive treatment in the UK

CI: Professor Ibrahim Abubakar (UCL)

Investigating a new sputum test (mycobacterial bacterial load assay) and a new blood test for human blood RNA signatures for monitoring the response to TB treatment to support infection control decisions, and guide effectiveness of treatment and its duration

PI: Professor Mahdad Noursadeghi (SHUB/UCL)

London Ambulance Service report form emergency call – possible COVID

 

Chest Xray showed infection in the top of the left lung- ‘indeterminate for COVID-19 ‘

 

Diagnosis: Patient with known HIV presenting with sputum smear positive pulmonary TB

A recent patient at the South Hub presented with back pain and was found to have spinal, pleural and pulmonary involvement
 

Steve Hitchins, Chair of Whittington Health NHS Trust from 2014 until June this year, sadly passed away unexpectedly recently. He was always hugely supportive of the North Central London TB service.
http://islingtontribune.com/article/steve-was-a-giant-of-islington-political-life

Professor Mahdad Noursedeghi (South Hub/UCL) and colleagues published that the presence of a blood gene transcriptional 'signature' in people who had been in contact with someone with TB, had a positive predictive value of 50% and a negative predictive value of 99.3% for progression to active tuberculosis within 90 days. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz252/5421263

 

It is great news that the recruitment target of >100 volunteers has been achieved for a follow up study to further understand how and why immune response to TB differs between people

I am pleased to announce the revamped North Central London TB Service website.

 

It includes information on TB, the services we offer and web based self-referral forms.

 

Many thanks to Richard Megroff and the IT team at Whittington health for helping to design this.

Amanda McCormack (TB nurse specialist South Hub/prison liaison lead) featured with one of our current patients on National Prison Radio, as part of a campaign launched on World TB day, to raise awareness about TB amongst people that live and work in prisons.

Well done to the prison health care team headed up by Dr Deyaa Al Kurdi who made the early diagnosis on this prisoner by sending sputum samples even before a chest Xray (right)!

 

Rates of active TB in places of prescribed detention in the UK are high compared with the general population. They have high rates of loss to follow-up care and poor treatment outcomes.

Recently an asymptomatic 15 year old boy, screened in the Unaccompanied asylum seeking young person infection screening clinic at UCLH had a chest X-ray which revealed a very small shadow in the top of the left lung (pictured).

 

Induced sputum at the South Hub confirmed isoniazid resistant TB - screening identifies both latent and active TB cases.

Dr Jonnie Cohen (South Hub/UCLH), presented the results of a national survey on clinical practice at the British Association for Paediatric TB In Manchester in February. This will inform the paediatric TB national guideline under development.

 

At the conference Lusha Kellgren (TB nurse lead South Hub) found the lecture theatre named after her grandfather - the first Professor of Rheumatology in the UK.

Belated congratulations to Narinder Boparai (NCL TB Network Screening Lead, pictured left) who presented a poster at the Winter British Thoracic Society meeting on the excellent work she has done on standardising TB incident management across the North Central London TB Network.

 

There were 148 incidents reported in one year: 43.2% were in a healthcare settings highlighting the importance of healthcare workers to be alert to the possibility of TB.

Angelita Solamalai (pictured) retired after 15 years as TB lead nurse at the RFH. We wish her all the best for the future.

 

Welcome to Josiane Dos Santos and Madeleine Wickers our new outreach worker and TB Case worker.

Congratulations to Steve Morris-Jones (Microbiology South Hub/UCLH) and his family (pictured) who successfully cycled the 875miles from Land’s End to John O’Groats and raised >£3000 for TB Alert, https://www.justgiving.com/fundraising/gingermojo-LEJOG

 

TB Alert, a UK based charity which works to tackle TB in the UK and the developing world was founded by Ken Citron and others. In the attached document he forwarded, he reflects on his life in relation to tuberculosis including having pulmonary TB himself which was cured with rest, relaxation, good food and sea air in Broadstairs!

It is with great sadness that we heard of the recent death of Professor Denny Mitchison. He was involved in key advances in the last 70 years:

 

The North Middlesex team hosted a TB training session for health care professionals and 3rd sector workers. Thomas Rendal (TB nurse lead, N Mid) in action (left).

NCL TB sector has welcomed the first student nurses on rotation from Middlesex University. Well done to Peter McKenzie (TB nurse specialists N Mid) for organising

60 year old found collapsed in the street with complete memory loss.  He did not know who he was or where he lived.

 

We wish all the best to Maria McEwan (TB nurse specialist S Hub) and Astrid Grindlaye (Outreach worker) in their new (not completely) unrelated) posts.

 

Welcome to Maddie Wickers (TB outreach Care worker), Zandile Maseko (research nurse), Damien Ming and James Milburn (ID/micro SPR Whittington/South Hub).

Health care professionals and 3rd sector workers were invited to an excellent session organised by Trevor Hart (Outreach worker) with support from Astrid Grindlay (Outreach worker), Jacqui White (lead nurse) and Jennifer DeKoningh (lead admin).

 

Steve Hitchins, Whittington Health chairman, was a welcome audience member

Left to Right Sue Wilders (Social Care team leader), Trevor and Josie (ex patient).

http://blogs.lshtm.ac.uk/alumni/2016/09/28/in-memory-of-professor-stephen-lawn/

 

Steve worked at, and was supportive of the NCL TB service -South Hub.

 

He is best known for his work on HIV TB in South Africa. This was a moving meeting celebrating the recent findings of the STAMP study on rapid urine testing for disseminated TB in HIV positive patients which he set up

 

 

Steve, 3rd from left at South Hub 1st anniversary party

Meena Middleton (TB nurse specialist South Hub, committee member for the “British Association for Paediatric Tuberculosis") attended the 2nd International Meeting on childhood tuberculosis in Vilnius, Lithuania.

 

A highlight was a debate on bedaquiline /delamanid dispersible tablets (not currently licensed for <18 year olds) replacing injectable agents in childhood MDR-TB

 

Patient on anti-TNF alpha treatment for ankylosing spondylitis, attended A&E with persistent cough.

Referred that day to South Hub . Spot sputum smear +ve.

 

Recent paper co-authored by Drs Mike Brown (South Hub/UCLH) and Marc Lipman (RFH) reported that Spot Sputums as good as Early Morning Sputums – research already in clinical practice https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0947-9

Congratulations to Mahdad Noursadeghi (UCL/South Hub) who has been awarded this research grant.  He writes:

 

I aim to test whether our individual risk of tuberculosis disease may be due to differences in the way our immune systems respond to infection and that these differences are genetically inherited.

 

We will measure the activity of immune genes at the site of a skin test for TB as a model for how the immune system functions at the site of real disease. We will then link differences in immune responses between people with the infection with differences in their genetic code and the likelihood of their infection progressing to disease. These studies will reveal how and why some people develop the disease while others control the infection.

 

The findings will help us target preventive therapies to those who need them most and to develop better vaccines or new treatment for TB aimed at improving immunity.