Setting: Regional thoracic clinic in tropical Australia.
Objective: To document recent experience with tuberculosis in Far North Queensland, Australia, with particular reference to tuberculosis in indigenous people.
Methods: Retrospective survey of all cases of tuberculosis in Far North Queensland between January 1993 and December 1997.
Results: There were 87 cases of tuberculosis; 54 were pulmonary, of which 67% were sputum smear-positive. Crude annual incidence of tuberculosis in indigenous people was 35.9/100,000 population compared to 2.32/ 100,000 in non indigenous people. There were 15 deaths, seven of which were felt to be avoidable. Nine of 11 relapses of previously treated disease occurred in Aboriginals. There were six cases of initial drug resistance, of which four were imported from overseas. Contact tracing identified four active cases of tuberculosis and 102 recently infected contacts. Preventive treatment in infected contacts was completed in only 41%, largely because of poor compliance related to alcohol consumption.
Conclusion: Tuberculosis remains common in Far North Queensland, with excess cases observed mainly in the indigenous population. Aboriginals are at high risk of both death from and relapse of tuberculosis. Tuberculosis control in indigenous people scattered over such a vast area remains challenging, and the results at present are sub-optimal.