Reviewed on : 20 Sep 2024

Reviewed by : Gorana Kovacevic & Jane Craig Health Protection Programme Manager

Expires : 20 Sep 2026

Advice & Guidance:

Monday to Friday: GPs can seek advice from the Infectious Diseases doctor during working hours over the phone via ID secretary Jennifer Chester-Morgan on 02476 966205 or you could use Advice and Guidance on the NHS eReferral Service.

Urgent requests for the advice can be discussed over the phone directly with the member of the Infectious diseases team via main switchboard (UHCW 02476 964000).

Advice Out of Hours: provided by the on-call microbiology or virology team (UHCW 02476 964000).

Referral pathway for outpatients clinics is online via the NHS eReferral Service (Specialty: Infectious Diseases).

Advice ID Ward 31 UHCW 02476 967844

Referrals are accepted for the suspicion of the following conditions:

1. Tuberculosis (TB), both active and latent (for TB see section below)
2. Chronic hepatitis B
3. Recurrent infections or difficult to treat infections (recurrent UTI’s, skin infections including HSV, VZV, cellulitis, erysipelas, non-resolving or chronic skin infections)
4. Periodic fever
5. Pyrexia of unknown origin
6. Traveller related infections
7. Lyme disease
8. Suspicion of the chronic fatigue syndrome
9. Complicated and/or rare infections (Non-TB mycobacterial infections, fungal infections, infections due to multidrug-resistant pathogens, complex bone and joint infections)

Referral information should include:

Relevant clinical details including travel history and physical examination.

Relevant tests requested or awaited, especially if performed in other Trusts or overseas e.g. FBC, erythrocyte sedimentation rate (ESR), U&Es, C-reactive protein (CRP), LFTs, antinuclear antibody (ANA), Rh factor, TFTs ,Hepatitis screen, HIV, positive microbiological samples (sputum, urine, blood culture), CXR or any other imaging if available

ID (UHCW) provides two outpatients clinic services:

• Tuberculosis (TB) clinic (see below) is offered to all suspected or confirmed cases of active or latent TB including those with complex medical needs – such as HIV/TB dual infection and multi-drug resistant TB – and is part of the wider Coventry and Warwickshire TB service.
• The Infectious Diseases (ID) clinic is for patients with suspected or confirmed infection. It is a service for patients who do not need acute admission but warrant ID assessment and management.

We aim to see referral within 2 weeks of referral or earlier if active TB for example.

ID Consultants :

• Dr Vjeran Cajic
• Dr Gorana Kovacevic
• Dr Evangelos Vryonis

Coventry & Warwickshire TB Service

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium Tuberculosis and commonly affects the lungs, but can reach any part of the body

It is usually spread by the coughing of an infected person, but is not generally regarded as highly contagious

Providing meds are taken correctly, patients who clinically respond to treatment are regarded as non-infectious after two weeks of treatment and if able, may return to work

Prolonged close contact with a person with TB is usually necessary for infection to be passed on, for example, where people are living in the same household and/or spending a cumulative period of eight hours or more with a smear positive pulmonary case

Up to a third of close contacts of an infectious respiratory TB case may become infected.  Of those infected, 10% will develop active disease at some time.  In half, this is within two years (primary TB), particularly in children and young adults.  In the remainder the dormant infection (latent TB infection) reactivates many years later (reactivation)

It may take many years before someone infected with TB develops the full disease

TB is curable with a course of special antibiotics taken for at least 6 months and those with suspected latent TB require 3 months chemoprophylaxis

The TB nurses specialists will identify and assess individuals at risk and inform GP’s of all screening outcomes. 

The symptoms of TB: 

• Cough for three weeks or more 
• Haemoptysis,  
• Weight loss
• Night sweats lasting more than 2 weeks, characteristic CXR appearances or positive microbiology 

All those suspected or confirmed with TB should be managed by clinicians who have regular and continuing experience of the condition and treatment is supplied to the patient free of charge irrespective of their immigration status

 Groups considered to be vulnerable to TB:  

• Individuals born in high TB incidence countries now residing in the UK 
• Those who misuse alcohol and or drugs and/or who are homeless 
• Those with HIV infection 
• Those who are on long-term, high dose steroid treatment 
• Those suffering with immune-suppressive disorders such as leukaemia 
• Those taking anti TNF therapy 
• The elderly and very young  
• Those with malnutrition 

As well as caring for patients with TB, the team identifies and undertakes all necessary contact tracing among household and other ‘close’ contacts

The team also manages TB incidents where potential transmission of TB to non-household contacts is identified, warranting wider public investigation beyond routine contact tracing, such as in a school or workplace 

BCG vaccine

National policy (Green Book Chapter 32 Tuberculosis Department of Health for  BCG vaccination) recommends immunisation for the following groups provided BCG immunisation has not previously been carried out, the tuberculin skin test (where required) is negative and there are no other contraindications such that individuals are known or suspected to be immunocompromised, including those infected with HIV: 

In an area with a low incidence of TB the BCG vaccination is offered to selected neonates before discharge or  through maternity service clinics to those who:  

• Were born in an area with a high incidence of TB or 
• Have one or more parents or grandparents who were born in a high-incidence country, or 
• Have a family history of TB in the past five years

Mantoux testing should not be done routinely before BCG vaccination in children younger than six years

Maternity units are responsible for this provision across Coventry and Warwickshire.

Eligible infants missed at birth will be identified by Health visitors and referred back to BCG clinics until the child is 12 months old

The TB service is responsible for offering BCG to eligible infants (up to 12 months of age) who transfer into Coventry and Warwickshire – please refer to the TB team directly 

Individuals over 16yrs seeking BCG vaccination may need to be referred to a private travel clinic for tuberculin testing and BCG vaccination

The TB specialist nurses will only offer BCG vaccinations in the community to those who are eligible infants, who have moved into the areas (as above), as well as those who are under 16 and eligible according to the Green Book, and those who have been screened as TB contacts

References

• Green Book Chapter 32 (2013) Tuberculosis Department of Health. BCG vaccination 
• NICE guidance (NG33)  
• PHE TB epidemiology 

Contact

Coventry & Warwickshire TB Service

Paybody Annex Building – Estates (At the rear of Paybody)

City of Coventry Health Centre 2 Stoney Stanton Road Coventry, CV1 4FS

Tel: (024) 76964169 

Email: covwarkstbteam@uhcw.nhs.uk

The service works Monday – Friday 0830-1630hrs

The team: Administrator, Specialist TB Nurses and Health Care Support Workers

Work and support the TB clinics in acute service but mostly visit patients and their families/ contacts in their homes and work places.

Referrals

• If suggestive of TB, urgently refer to TB clinic
• 2 week Tuberculosis clinic appointment needed.
• Arrange via Respiratory Consultants secretary (see below)
• If patient is ill and needs admission, please see TB referral pathway for more details.

TB Referral Pathway UHCW 

TB Referral Pathway George Eliot and Warwick Hospital (SWFT)

Baseline Investigations and Actions

Recommended baseline investigations organised by GP :FBC, U+Es, LFT’s  &  CRP 3 x sputum’s for AFB TB culture CXR

Public Health England (PHE) and TB Incidents

An ‘incident’ is where potential transmission of TB to non-household contacts is identified, warranting wider public investigation beyond routine contact tracing.

Overseen by Public Health England (PHE) and  includes potential TB transmission in the following settings;

• Educational setting involving a child, student or member of staff
• Prison, reception centre or detention setting
• Healthcare setting involving a patient or healthcare worker
• Aircraft exposure to passengers or staff
• Patients warranting public health action, such as applications made under the Part 2 A Public Health Act 1984