tb cases in croydon. 23 yo woman 28/12/13 ae: back pain increased frequency smelly dark urine ...

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TB Cases in Croydon

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Page 1: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

TB Cases in Croydon

Page 2: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 1 – 23 y o mother

23 yo woman 28/12/13 AE:

Back pain Increased frequency Smelly dark urine

No PMX

Back pains for 2 years Seen by GP 3 months ago - ? Renal stones Seen by a different GP in Dec 2013

▪ Spine Xrays done SHx

From Pakistan, Married, one child 16 months old Never smoked/ no alcohol

Fx Mother TB

Page 3: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 1 – 23 y o mother

OE: Low BMI Chest clear, abdo soft Urine DIP = +++

Bloods: CRP 152 WCC 20 (neut 17)

Page 4: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

28th Dec 2013

Page 5: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

December 2013

Page 6: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

January 2012 (!)

Page 7: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

CT guided biopsy

Page 8: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 1 – 23 y o mother

D/W Ortho

Neuro surgeons Bed rest and brace

Start Treatment

Moved to Pakistan ??F/U

Page 9: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 2 – 27 yo Indian woman

Unwell with cough for a while

No CXR till admitted to hospital

Kept in an open bay

Screening for Pts and staff

Page 10: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

March 2013

Page 11: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

April 2014

Page 12: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

October 2013

Page 13: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 - homeless immigrant 42 y0 Collapsed on a street No English

2/12 Hx of cough and weight loss

From India, In UK since 2008

Homeless/Currently living with ? friends Odd work - Painter/decorator ? illegally living in UK

Page 14: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

31st March 2013

Page 15: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 – homeless immigrant Bloods: CRP 98 Plt 6 Lymph 0.5

AFB in sputum +++

DS: Milliary TB ITP

Page 16: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 – homeless immigrant

Severe malnutrition Cardio-respiratory arrests x 2 Very prolonged stay in hospital Repatriated back to India

Page 17: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 – homeless immigrant

24 APRIL 2013 30TH JUNE 2013

Page 18: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 – homeless immigrant

AUGUST 2013 NOVEMBER 2013

Page 19: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 3 – homeless immigrant

MARCH 2013 JAN 2014

Page 20: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 4 – Doctor

34 yo Doctor Unwell, “something is not right”

Cough with strange sensation in the chest

Page 21: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by

Patient 4 – Doctor

JUNE 2013 DECEMBER 2014

Page 22: TB Cases in Croydon.  23 yo woman  28/12/13  AE:  Back pain  Increased frequency  Smelly dark urine  No PMX  Back pains for 2 years  Seen by