Tuberculosis in Vascular surgical patients:
Peripheral Vascular disease patients are usually smokers and there is a good possibility that they had tuberculosis at some point of time in their life. Recently a 50 year old smoker was referred to our clinic (emaciated and BMI less than 18) with left upper limb ischemia.Clinically he looks like a patient of tuberculosis. X-ray showed changes of chronic both lung disease and fibrosis. The physicians are hesitating to admit the patients after Brachial artery thrombectomy in the TB hospital as they are not convinced of the active nature of the tuberculosis. Surgeons are hesitant to admit such a patient in the surgical ward where more than 15 Post operative patients are lodged with common toilet facilities.We can do the thrombectomy under local anesthesia in 15-20 minutes safely. After that it is advisable to treat such patients in outpatient departments safely. It took more than 1 hour to convince the patient and his relatives to accept and wear a face mask to prevent the spread of potential tuberculosis or other diseases to the neighbors. In a recent Lancet report it was mentioned that although tuberculosis prevails in mainly high-burden developing countries, cases in immigrants in many low-incidence countries are increasing substantially. This changing pattern of disease is clear in the UK where, between 1998 and 2009, tuberculosis notifications have risen by 46%, from 6167 cases to 9040, with much of this rise fueled by the 98% increase in cases from overseas.These individuals account for nearly three-quarters of all tuberculosis notifications in the UK with an incidence that is 20 times higher than in UK-born individuals (89 cases per 100 000 people per year vs 4 per 100 000). We have to note importance of these reports more seriously and provide or display information about tuberculosis to the patients in the high turnover hospitals (in notice boards or as wall posters) at regular intervals to sensitize the patients about the possibility of easy spread of Tuberculosis bacilli which are getting resistance to the currently available drugs.
