Imperial School of Anaesthesia

Tuberculosis is a disease which imposes considerable burden on both the global population and health service. Over the next twenty years, a billion people will become newly infected with it, and thirty five million will die as result of it1 The 2003, the WHO reports a 0.4%/yr growth rate in the incidence of infection, although rates vary with geographical location; this is particularly evident in areas of sub-Saharan Africa (figure one).

figure one estimated tuberculosis incidence rates 2001, WHO
Based on the preliminary figures from Health Protection Agency, this pattern of increasing incidence is also true in the UK: Compared with 1988, there have been nearly two thousand more cases of tuberculosis in 2001, now over 6600, with an increased rate of 9.4 to 12.7 per 100000 population over the same period. Again, there is geographical variation, notably with London accounting for 41% of all infections3 A number of factors are thought to be responsible for the increasing incidence of infection, including HIV infection, poverty and overcrowding, travel and migration, inadequacies in tuberculosis control programmes and treatment, and the insurgence of multi-drug resistant bacteria4 Therefore it is clear the problem that tuberculosis poses to the population as a whole. However, as with many diseases, when it occurs in the context of childhood, there are a number of pathogenic differences and additional clinical difficulties involved in its management. Although due to varying levels of reporting and diagnostic problems data is not readily available, Atkinson et al. showed that the incidence of paediatric tuberculosis infection in London is increasing similarly to the general picture (figure two) Despite this, rates of paediatric infection are generally low in developed countries, primarily due to better prevention programmes; the problem in developing countries, where contact tracing, treatment of adult infection and other measures are less well practised, is of worrying significance.

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		Tuberculosis is a disease which imposes considerable burden on both the global population and health service. Over the next twenty years, a billion people will become newly infected with it, and thirty five million will die as result of it1 The 2003, the WHO reports a 0.4%/yr growth rate in the incidence of infection, although rates vary with geographical location; this is particularly evident in areas of sub-Saharan Africa (figure one). figure one estimated tuberculosis incidence rates 2001, WHO Based on the preliminary figures from Health Protection Agency, this pattern of increasing incidence is also true in the UK: Compared with 1988, there have been nearly two thousand more cases of tuberculosis in 2001, now over 6600, with an increased rate of 9.4 to 12.7 per 100000 population over the same period. Again, there is geographical variation, notably with London accounting for 41% of all infections3 A number of factors are thought to be responsible for the increasing incidence of infection, including HIV infection, poverty and overcrowding, travel and migration, inadequacies in tuberculosis control programmes and treatment, and the insurgence of multi-drug resistant bacteria4 Therefore it is clear the problem that tuberculosis poses to the population as a whole. However, as with many diseases, when it occurs in the context of childhood, there are a number of pathogenic differences and additional clinical difficulties involved in its management. Although due to varying levels of reporting and diagnostic problems data is not readily available, Atkinson et al. showed that the incidence of paediatric tuberculosis infection in London is increasing similarly to the general picture (figure two) Despite this, rates of paediatric infection are generally low in developed countries, primarily due to better prevention programmes; the problem in developing countries, where contact tracing, treatment of adult infection and other measures are less well practised, is of worrying significance.
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