Cases of tuberculosis have risen by more than a fifth in England and Wales over the last decade, according to a report.

Last year there were 5,658 cases, compared with 4,659 a decade ago.

London is at the heart of many of the outbreaks.

More than half occur in people born outside the UK, of whom four in 10 have arrived in the previous five years.

A research project carried out by the Public Health Laboratory Service and the British Thoracic Society (BTS) suggests that many areas battling the disease have inadequately trained nurses to deal with it.

The results are to be presented at the BTS winter meeting in London, where TB rates are four times higher than in the rest of the country. TB cases in the capital have risen by a third since 1993.

TB had been thought to be a declining disease, due to improved living standards and better eradication treatments.

Dr Peter Ormerod, of Blackburn Royal Infirmary, surveyed 43 health districts to see whether they met minimum standards for health and clerical staff to help treat and monitor disease levels.

Only 14% of districts passed the test, which requires one TB nurse or health visitor and full clerical support for every 50 cases seen in a year.

Homeless vulnerable

Dr Ormerod said: "TB is not a disease of the history books. It is vitally important that we continue to invest in measures to combat the disease, especially in areas of high incidence.

"This survey suggests we are dropping our guard, and we must address this."

TB, a virulent lung infection, is most likely to develop in poorly nourished individuals, or those in poor living conditions. The homeless are particularly vulnerable.

Also at risk if they acquire the infection are those with the HIV virus, because their depressed immune system offers no protection.

It is often the infection which leads to, or contributes to, the death of HIV-positive patients.

Modern drug treatments can beat the disease, although many strains of tuberculosis are now becoming resistant to them