Reviewed on : 1 Apr 2022

Reviewed by : Gorana Kovacevic & Gateway Editor

Expires : 1 Apr 2024

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 Community TB Service

(for referral pathways see bottom of page or link right)

Room 3021, City of Coventry Health Centre,  2 Stoney Stanton Road, Coventry CV1 4FS

Tel 02476 961 351     Monday – Friday 0830-1630hrs Email: uhc-tr.covwarkstb@nhs.net

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 Follow link

TB Referral Pathway George Eliot and Warwick Hospital (SWFT) Follow link

Baseline Investigations and Actions

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

Contact TB community team 0830 -1630hrs for advice/discussion Tel: 02476 961351 Email: uhc-tr.covwarkstb@nhs.net

Aims:

• Reduce the risk of acquiring new tuberculosis infection within Coventry and Warwickshire and prevent secondary cases
• Minimise morbidity and prevent mortality while ensuring treatment completion
• Prevent the emergence of drug resistance, particularly multi drug resistant tuberculosis (MDR TB and XDR TB)
• Management by clinicians with regular and continuing experience of the TB
• Treatment is supplied to the patient free of charge.
• All patients have named case workers
• Providing treatment is taken correctly, patients clinically responding to treatment are regarded as non-infectious after two weeks of treatment and may be able to return to work.
• TB is curable with targeted antibiotics taken for at least 6 months and those with suspected latent TB require 3 months chemoprophylaxis.
• TB nurses specialists will identify and assess individuals at risk and inform GP’s of all screening outcomes.
• Identification and contact tracing among household and other ‘close’ contacts

Vulnerable groups

• HIV infection
• Long-term, high dose steroid treatment
• Immuno-suppressive disorders eg leukaemia
• Anti TNF therapy
• Elderly and very young
• Homeless
• Alcohol / drug misuse
• Malnutrition
• Born in high TB incidence countries now residing in the UK

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

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 refer back to these BCG clinics until the child is 12 months old.

The TB service is responsible for offering BCG to eligible infants (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.

BCG Vaccine Enquiries

Contact Telephone (UHCW): 02476 967404