The spectrum of mycobacterial disease in a Dublin teaching hospital

We describe our experience at our combined tuberculosis and public health clinic, which has been in existence since 1991, and compare it to a previous review of tuberculosis at St. Vincent's Hospital from 1974 to 1979. A total of 107 patients were treated, 58 male and 49 female, with a mean age of 53 years. Seventy-seven patients had pulmonary tuberculosis, 23 extrapulmonary and three had both. Four patients had miliary tuberculosis. Our figures reflect the fall in incidence of tuberculosis in Ireland since the 1970's and a rise in smear negative and presumptive cases. The epidemiology of tuberculosis in Ireland is little changed except for an increasing impact of immigration. Problems such as late diagnosis, especially in older patients, and non-compliance remain significant. In addition, there were four deaths from tuberculosis. However, our combined clinic has led to the appropriate management of patients by Respiratory Medicine specialists and a great move to ambulatory diagnosis and management. We believe it is the best model for the effective management of tuberculosis in Ireland.