Tuberculosis in an area bordering East London: Significant local variations when compared to national data

From September 1996 to June 1997, in an area bordering East London, we pros pectively collected epidemiological, clinical and microbiological data on a ll patients with newly diagnosed culture-positive tuberculosis and compared these to national data based on notifications. The significant differences were that tuberculosis was diagnosed almost exclusively in non-Caucasian p atients (42/47 [89%]) and that there was a high percentage of extra pulmona ry tuberculosis (27/47 [57%]) including four cases of tuberculous meningiti s and five cases cf osteomyelitis. We also observed that 19/27 (70%) of pat ients with extrapulmonary tuberculosis had normal chest X-rays, 3/17 (18%) sub-Saharan Africans were HIV antibody-positive and drug resistance strains were isolated from six sub-Saharan Africans and one Caucasian, Figures for treatment failures and mortality compared favorably to national averages a t 6 months, National data do not accurately reflect local epidemiology and clinical presentations. Hospital-based surveillance and promoting awareness of local differences is essential to prevent delayed diagnosis, inappropri ate management and poor clinical outcome.