An inquiry into last year's severe tuberculosis (TB) outbreak at a Wandsworth nursery has criticised doctors for communications breakdowns, late diagnoses and late treatment.

The teacher who spread the disease at the Wee Ones Nursery, known only as Ms X, began showing symptoms in 1999, but was only diagnosed correctly in spring 2001, despite seeing GPs, an osteopath and other specialists over two years.

TB is spread through the air from person to person, usually during coughing and sneezing, and Ms X infected 41 children and 14 adults. Another 10 children and two adults suffered the full-blown disease.

The teacher was probably highly infectious from the start of 2001, though she continued working, and pupils at the nursery school, siblings, parents, staff, nannies and 143 more contacts of Ms X had to be screened in a huge investigation.

The inquiry believes she picked up the infection during a trip through North Africa, and its report catalogues the "series of factors rather than one catastrophic failure" that led to the outbreak.

l Ms X, like many busy people, would attend surgeries at short notice, meaning she rarely saw the same doctor. Over two years, no medical staff saw her regularly enough to get to know her well.

* The GPs' computerised system meant relevant details of her case history could not be seen easily on-screen.

* Ms X failed to mention relevant symptoms, including her weight loss, but "it is the duty of the clinical professional" to encourage the patient to give a full case history, rather than expecting them to say what they think is relevant.

* Ms X's private osteopath should have reported unusual symptoms to her GP.

* TB could have been diagnosed from an abnormal x-ray in September 1999, but was missed, and abnormal blood tests were not followed up with further investigations, despite a chest x-ray being the "obvious" action.

The report said there were lessons to be learned about doctors' computer skills and "listening to patients", but said the most important lesson was that "TB is still prevalent in the twenty-first century". It added: "Rare illnesses do occur!"

July 17, 2002 11:00