MYCOBACTERIAL INFECTION IN AN INNER-CITY CHILDRENS-HOSPITAL

Childhood tuberculosis is perceived by many as a disease of the past. Experience in a children's hospital serving a deprived population sugg ested that tuberculosis and other mycobacterial infections were not de clining in clinical practice. Fifty three tuberculous and 11 atypical mycobacterial infections were identified between 1978 and 1992. There was no decline in tuberculosis and nine of the 11 atypical infections occurred in the last five years. Altogether 40% of cases of tuberculos is were in non-Asian children; 32% had arrived in the UK or visited fa mily overseas in the previous year; and 38% had a history of tuberculo sis contact, usually a close adult relative. Nationally, the previous decline in tuberculosis in all ages has reversed. In the local health districts in London's east end, childhood tuberculosis has also stoppe d declining , and seems to be increasing. It is regrettable that BCG v accination has been abolished by some districts in the UK, against cur rent recommendations. Childhood tuberculosis is still common in the pr actice described here, including among children who do not fall into c onventionally recognised high risk groups. Inner city dwellers and jun ior doctors are both highly mobile populations, adding to the risk tha t paediatricians, particularly those in training, may encounter tuberc ulosis with little or no previous experience of the condition.