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Final Issue: Volume 16 Number 51
Published on: 21 December 2006
Final Issue in PDF
Last updated: 2 November Volume 16, No.44 (PDF file, 213 KB)
CDR Home | News
Final data on tuberculosis cases reported to the Enhanced Tuberculosis Surveillance system in 2005, and the outcome of treatment for cases reported in 2004 have been published on Health Protection Agency (HPA) website. An HPA newsletter also released today provides an update on the national tuberculosis situation and current initiatives contributing to the control of tuberculosis in the United Kingdom . Both the latest data and the newsletter are available at <http://www.hpa.org.uk/infections/topics_az/tb/menu.htm>.
In 2005, a total of 8113 tuberculosis cases were reported in England , Wales and Northern Ireland, a rate of 14.7 per 100,000 population. The number of cases reported increased by 11% between 2004 and 2005. There was a 7% increase in the number of pulmonary cases and a 17% increase in the number of extra-pulmonary cases. The majority of tuberculosis cases continue to occur in the non-UK born population (72% in 2005).
Between 2001 and 2004, the proportion of tuberculosis cases in which the outcome of treatment was reported increased from 79 to 86%, while the proportion of cases completing treatment remained constant at around 78 to 79%.
The continuing increase in tuberculosis incidence in England, Wales, and Northern Ireland re-enforces the need for the continued surveillance of the disease and highlights the importance of working towards the goals outlined in the Chief Medical Officer's Tuberculosis Action plan .
1. Department of Health. Stopping tuberculosis in England: an action plan from the Chief Medical Officer. London: Department of Health, 2004. Available at <http://www.dh.gov.uk/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/
Since July 2006, there has been a marked increase in the number of Paecilomyces variotii isolates referred to the HPA Mycology Reference Laboratory (MRL) in Bristol for identification, and in some cases susceptibility testing. Nineteen P. variotti sterile site isolates (all except four from blood culture) have been received by MRL since 1 July 2006, compared with the usual 5 to 6 isolates received per year. The isolates originated from 14 laboratories with a wide distribution around England, to whom the Centre for Infections is grateful for highlighting the issue. A further 20 cases of suspected 'pseudofungaemia' caused by P. variotii from seven laboratories have been reported to MRL, bringing the total number identified to nearly 40. Antifungal susceptibility testing suggests that two distinct strains are involved, although morphologically the isolates are similar and differ in appearance from the usual P. variotii strains.
P. variotii is a common environmental filamentous fungus, present in soil and decaying vegetable matter. Although P. variotii is occasionally associated with human infection and is an emerging pathogen in immunocompromised patients , invasive infection is rare, raising the likelihood of contamination with consequent implications for patient management. No source for these suspected contaminants has been identified although it is clear that at least two different blood culture detection systems are in use at the different hospitals.
P. variotii may be misidentified by laboratories as Fusarium or Cladosporium but can be distinguished by the production of long non-branching chains of oat-shaped cells produced from long, delicate phialides. Isolates identified to date have a less powdery appearance, more floccose aerial mycelium and a less distinct khaki colour than is usual for this species. Laboratories should carefully question the clinical significance of any Paecilomyces spp. identified. For further information on the identification of isolates or other mycological advice, contact Elizabeth Johnson at the Mycology Reference Laboratory, Bristol, tel: 0117 9285028 / 0117 9291326; email firstname.lastname@example.org.
Further investigation of these apparent pseudofungaemias is being undertaken by the HPA Centre for Infections (Healthcare Associated Infection and Antimicrobial Resistance Department and Mycology Reference Laboratory). Laboratories who have identified this mould since the beginning of July 2006 are requested to contact Colin Campbell at the Centre for Infections, tel: 020 8327 7146; email: email@example.com.
All laboratories prospectively identifying any Paecilomyces variotii isolates are asked to keep the isolates and take a record of events around the blood culture taking process, details of the patient and the interpretation of the blood culture results to facilitate our investigation. For instance, who took the blood culture, their procedure (for example, prior hand washing; whether rubber tops of the blood culture bottles were disinfected and alcohol allowed to evaporate first; whether patient's skin was disinfected and what wipes were used), what type of venepuncture set was used (plus manufacturer), whether blood was taken from a peripheral vein or from an indwelling line, type of indwelling line, were other blood collection tubes filled before the blood culture set (if so, which types of bottles eg EDTA and manufacturer), type of blood culture system used and which bottle(s) were positive. This will help determine the source of the contamination.
1. Groll AH, Walsh TJ. Uncommon opportunistic fungi: new nosocomial threats. Clin Microbiol Infect 2001; 7: 8-24. Available at <http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1469-0691.2001.tb00005.x>