Symptoms of pulmonary tuberculosis in consecutive smear-positive cases treated in Ethiopia

The purpose of the study was to define in detail the usually accepted respiratory and non-respiratory symptoms of newly discovered smear-positive pulmonary tuberculosis in a group of Ethiopians. There were 163 consecutive patients referred to the weekly Chest Clinic at the Tuberculosis Demonstration and Training Centre in Addis Ababa.The results showed that more than 5% of pulmonary tuberculosis cases had respiratory symptoms of less than 2 weeks. Some symptoms such as haemoptysis, chest pain and dyspnoea prompted early reporting while there was a delay in reporting other symptoms such as cough, in spite of cough being present in all patients. Most of the non-respiratory (constitutional) symptoms were reported fairly early.A history of tuberculosis contact was relevant in this group of patients. A negative Mantoux test was noted in 20% of patients.     

Critical assessment of smear-positive pulmonary tuberculosis patients after chemotherapy under the district tuberculosis programme

This is a status report of a retrospectively assembled cohort of 3357 smear-positive patients initiated on anti-tuberculosis chemotherapy in the North Arcot district between April 1986 and March 1988. The patients were contacted once at their homes between November 1988 and June 1989 (6 and 36 months after start of treatment), and information on their status, including death, could be obtained from 76% of them.Regimens were selected by the patients. 2306 (69%) had accepted short course regimens (SCC) and 1051 (31%) had been started on standard chemotherapy (non-SCC), 43% and 35% in SCC and non-SCC respectively had completed 80% or more of their treatment Overall mortality was 28%. Of those remaining, 31% had active disease and were excreting bacilli, among which 65% of the cultures were resistant to isoniazid and 12% to rifampicin. Combined resistance to isoniazid and rifampicin was seen in 4% and to isoniazid and streptomycin was seen in 19%.A significant finding was that even among those who had taken less than 50% of their treatment, 56% were bacteriologically negative. However, inadequate or irregular chemotherapy resulted in over four times the mortality and about twice the rate of smear positivity as compared with those taking adequate chemotherapy. No comparisons are made between patients on short-course and standard regimens as the patients selected their treatment and the groups are not comparable.     

A one-day method for the diagnosis of pulmonary tuberculosis in rural Ethiopia.

Smear diagnosis of pulmonary tuberculosis (PTB) requires three sputum examinations over 2 days. We evaluated the performance of two sputum specimens obtained on a single day (the second specimen submitted 1 h after the first) against the standard 2-day method in rural Ethiopia. A total of 243 suspects were enrolled; 52 had confirmed PTB: 49 (94%) were detected by the same-day method and 51 (98%) by the standard method (P > 0.5). The same-day approach would reduce the number of visits required for diagnosis, save resources for the health system and the patient, and ultimately improve case detection in poorer countries.     

Under-diagnosis of smear-positive pulmonary tuberculosis in Nairobi, Kenya.

SETTING: Nairobi City Council Chest Clinic, Nairobi, Kenya. OBJECTIVE: To determine if under-reading of sputum smears is a contributing factor in the disproportionate increase in smear-negative tuberculosis in Nairobi, Kenya. METHODOLOGY: Between October 1997 and November 1998, patients fulfilling the local programme definition of smear-negative presumed pulmonary tuberculosis were enrolled in the study. Two further sputum specimens were collected for examination in a research laboratory by fluorescence microscopy. RESULTS: Of 163 adult subjects enrolled, 55% were seropositive for the human immunodeficiency virus type 1 (HIV-1). One hundred subjects had had two pre-study sputum smears assessed before recruitment and produced two further sputum specimens for re-examination in the research laboratory; of these 19 (19%) were sputum smear-positive on re-examination and a further seven (7%) became smear-positive on second re-examination. CONCLUSIONS: Of those patients with smear-negative presumed pulmonary tuberculosis by the local programme definition, 26% were smear-positive when reexamined carefully with two repeat sputum smears. This suggests that the high rates of smear-negative tuberculosis being seen may in part be due to under-reading. This is probably as a result of the overwhelming burden of tuberculosis leading to over rapid and inaccurate sputum examination. Retraining of existing technicians and training of more technicians is likely to reduce underreading and increase the yield of smear-positive tuberculosis. This finding also stresses the need for regular quality assurance.     

Local perceptions of tuberculosis in a rural district in Malawi.

SETTING: Ntcheu district, Malawi. OBJECTIVE: To determine 1) the number of patients treated by traditional healers, 2) the type of diseases managed by them, 3) the perceived causes of these disease, and 4) how both patients and healers looked at tuberculosis (TB). DESIGN: In-depth interviews and structured questionnaires with traditional healers, and focus group discussions with TB patients and their guardians. RESULTS: Traditional healers recognized four main causes of disease, related to why the patient is sick rather than what the patient is suffering from. Two hundred and seventy-six traditional healers saw approximately 4600 patients a week, managing a variety of diseases, mainly of a chronic nature. Twenty-four per cent of patients seen by traditional healers had a cough, including patients with TB. Traditional healers believe they can cure TB, and have therefore been briefed on the infectious form of TB (smear-positive cases). The possibility of including traditional healers in early diagnosis has been explored. CONCLUSION: There is a need to address local beliefs in health education and possibly find ways of involving healers in supervision of treatment.     

Prevalence of smear positive pulmonary tuberculosis in Gondar prisoners,North West Ethiopia

Objective:To assess the prevalence and risk factors of smear positive pulmonary tuberculosis among Condar town prisoners.North West Ethiopia.Methods:A cross sectional study was conducted from February to July,2008 in Condar Prison.Prisoners with cough duration of more than two weeks were involved in the study by giving three sputum samples and filling the questionnaires prepared for risk factor assessment.Acid fast staining technique was employed to delect the presence of the Mycobacterium tuberculosis bacilli in the sputum samples.Data was analyzed using SPSS version13 computer software and presented in table.Chi-square test was used to assess associations and a P-value less than 0.05 was taken as significant.Results:A total of 384 prisoners,349 male and 35 females,with a mean age of 33.3 years were involved in the study.The prevalence of smear positive pulmonary tuberculosis among those prisoners with cough duration of more than two wecks was 8.59%.Only the length of imprisonment had a significant association(χ~2= 18.82,P-value0.0001) with the prevalence of tuberculosis.Conclusions:This study indicated that tuberculosis among prisoners with cough duration of more then two weeks in Gondar prison is very high.Therefore Periodic screening of the prisoners and screening of newly introduced prisoners should be practiced so as to minimise the burden of tuberculosis in prisoners.     

青年人涂阳肺结核临床特征

目的探讨青年人涂阳肺结核的诊治和管理措施。方法对135例青年人涂阳肺结核进行分析。结果青年人以咳嗽、胸痛、发热、纳差、消瘦、盗汗为主,病程短。结论早期诊断和治疗是改善预后的关键,积极查痰及胸部X线检查,以便及早发现,及早治疗。     

Screening childhood contacts of patients with smear-positive pulmonary tuberculosis in Malawi.

A survey was conducted by the National Tuberculosis Programme in 44 Malawian hospitals on screening young children aged 5 years or less in households of adults diagnosed with smear-positive pulmonary tuberculosis. Of 659 hospitalised adult patients, 267 (41%) had a total of 365 young children; 56 (21%) adult patients had been informed about childhood screening, and in 31 (12%) some of their children were screened. Of the 365 young children, 33 (9%) were screened for TB--23 received isoniazid preventive therapy, six received anti-tuberculosis treatment, and in four no action was taken. Steps are needed to improve childhood screening procedures.     

湖南省农村传染性肺结核患者发现延误的影响因素研究

目的　探讨社会经济、卫生服务、文化背景、症状、行为等因素对农村传染性肺结核患者发现延误的影响。方法　采取横断面调查方法 ,根据不同经济状况在湖南省随机抽取 4个县为研究现场。运用自制的调查问卷 ,在知情同意的前提下对到抽样县结核病防治所诊治、年龄在 15岁及以上的痰涂片阳性的肺结核连续患者逐一面谈。结果　共 318例痰涂片阳性的肺结核患者接受了面谈并完成调查问卷。从症状出现到被确诊为肺结核的平均总延迟时间为 84 6d(中位数 6 5 0d) ;平均就诊延迟和确诊延迟分别为 5 0 8d(中位数 30 0d)和 33 8d(中位数 2 4 0d) ;分别有 187例(5 8 5 % )和 2 0 0例 (6 2 9% )患者存在就诊和确诊延误。导致患者就诊延误的影响因素有 :有无咯血、居住地的距离、有无迷信行为、有无接受民间偏方行为和家庭人均年收入等 ;导致确诊延误的影响因素有 :性别、文化程度、是否接受抗结核治疗的宣传教育、有无迷信行为、有无接受民间偏方行为和患者对结核病的感受等。结论　需采取综合性干预措施 ,包括加强各级医疗机构医务人员有关国家结核病控制规划和相关专业技术的培训 ,合理设置结核病诊治点和广泛开展结核病健康教育等 ,以减少结核病患者的发现延误     

The outcome of tuberculosis treatment at a rural hospital in southern Ethiopia.

We evaluated the treatment results of 239 patients with sputum positive pulmonary tuberculosis (TB) and describe potential factors associated with reduced programme performance in aTB treatment programme in Ethiopia.The TB registry was incomplete and 64 (26.8%) patients were not recorded in the control programme. Of the 239 patients, 34.3% received short-course chemotherapy (SCC) as a first treatment, 5.9% received SCC having previously been treated with standard long-course chemotherapy (LCC), and 54.4% were initially put on LCC. After excluding the 75 patients (31.4%) who were transferred to other health institutions outside the control area, 100 (61.0%; 95% CI 53.0-68.4) were cured (22.6%) or completed the treatment (38.4%) falling short of the target of 85%. Five months or later during treatment 1.8% remained smear-positive, 7.3% died and 29.9% interrupted their treatment. Sputum tests were done in 78% of the eligible patients at 2 months, in 20% at 5 months and in 60.2% at the expected time of treatment completion. By July 1998, 5.4% of the patients initially on LCC had relapsed and were retreated with SCC. None of those initially cured with SCC needed to be retreated. Compared with patients in theTB registry, non-registered patients had lower treatment completed and cure rates (42.3% versus 65.2%; P = 0.047), more patients were transferred out of the TB programme (59.4% versus 21.1%; P<0.001) and the defaulter rate was higher (57.7% versus 24.6%; P=0.002). Weaknesses in the programme performance include organizational issues such as the under use of theTB registry, deficient follow-up procedures, the common usage of LCC and unsatisfactory rates of defaulting.     

痰涂片阳性肺结核患者成年家庭接触者患活动性结核病的风险

场所：土耳其伊斯坦布尔7个公共结核病防治所。 目的：调查伊斯坦布尔新诊断的痰涂片阳性肺结核患者成年家庭接触者（≥15岁）患活动性结核病的风险。 设计：对1997-2000年在伊斯坦布尔7家结防所登记的1570例结核病成年家庭接触者的回顾性分析。 结果：研究包括6188例家庭接触者（平均接触者／线索病例：3．9）,其中4114例（67％）大于15岁（平均接触者／线索病例：2．6）;3310例（80．5％）参加了接触者调查。平均随访时间2．2年（1～4年）;发现222例活动性结核病例（5．4％,95％可信区间5．2～5．6）,第一年发现171例。活动性结核发病率为2491／100000（15～34岁年龄组发病率3555／100000,大于35岁年龄组发病率1195／100000,P〈0．0001）。活动性结核病发病率最高的在15～24岁（8．5％）和25～34岁（6．5％）年龄组。 结论：涂片阳性肺结核患者的成年家庭接触者活动性结核发病率高。这样的高发病率说明化学预防治疗对于所有接触者,特别是年龄为15～34岁的接触者都是必要的,而不应仅仅用于儿童。     

Mycobacterial culture results of smear-positive patients with suspected pulmonary tuberculosis in Liverpool.

The aim of this study was to assess the final mycobacterial culture results of patients with smear-positive sputum or bronchial washings and to investigate the efficiency of local tuberculosis (TB) contact-tracing. Retrospective analysis of mycobacterial cultures and contact-tracing was performed in every patient with smear-positive sputum or bronchoalveolar lavage (BAL) in two Liverpool teaching hospitals (1996-1998). Of these patients 116 with smear-positive sputum or BAL were identified. Mycobacterium tuberculosis (M. tuberculosis) was cultured in 57 (49%), environmental mycobacteria in 37 (32%) and cultures were negative in 22 (19%) of the patients. Contact-tracing information was available in 107 of the 116 (92%) patients. A total number of 1,357 contacts were screened for possible tuberculosis. Of these, 420 (31%) were contacts of patients who cultured environmental organisms or had negative cultures. In this study, 51% of smear-positive patients in Liverpool did not have tuberculosis. Inefficiencies in current contact-tracing procedures have been identified which result from screening contacts of index cases that are subsequently found not to have cultured Mycobacterium tuberculosis. The authors believe that there are clear grounds for using rapid tests to identify and type mycobacteria more quickly than current solid or liquid media methods. It is also suggested that regional variations in the frequency of infection with environmental mycobacteria should be considered when formulating tuberculosis contact-tracing procedures.     

216例涂阳肺结核病人特征分析

目的　进一步掌握涂阳肺结核病人特征,以采取更有效的防治措施。方法 对2003—2004年9月的216例涂阳肺结核病例的资料和调查结果进行分析。结果 本组病人特征为:(1)文化程度不高,初中及以下为主,职业以农民为主。(2)男性是女性的2.13倍。(3)年龄高峰男性在25和35岁组,女性则在25和15岁组;有71.3%涂阳病人是54岁以下青壮年;在15～35岁年龄段,女性病人多于男性。(4)44.9%病人确认有肺结核病人接触史。(5)病灶侵及2个肺野以上165例(76.4%),有干酪和空洞46例(21.3%)。合并糖尿病27例(12.5%),合并有心脑血管病26例(12.0%),伴其他慢性病16例(7.4%),同时患其他肺外结核6例(2.8%)。(6)216例涂阳病人按卫生部统一化疗方案治疗,痰菌阴转率和治愈率均达到项目的要求。结论 进一步加强农村和青壮年的结核病控制工作,有助于加速结核病的控制。     

216例涂阳肺结核病人的临床特点分析

目的进一步掌握涂阳肺结核病人的临床特点,以采取更有效的防治措施。方法对2004～2005年9月的216例涂阳肺结核病例的资料和调查结果进行分析。结果本组病人特点为：（1）文化程度不高,初中以下以农民为主。（2）男性是女性的2．13倍。（3）年龄高峰男性在25和35岁组,女性则在25和15岁组;有71．3％涂阳病人是54岁以下青壮年;在15～35岁年龄段,女性病人多与男性。（4）44．9％病人确认有肺结核病人接触史。（5）病灶侵及两个肺野以上165例（76．4％）,有干酪和空洞46例（21．3％）。合并糖尿病27例（12．5％）,和伴有心脑血管疾病26例（12．％）,伴其他慢性病16例（7．4％）,同时有其他肺外结核6例（2．8％）。（6）216例涂阳病人按照卫生部统一化疗方案治疗,痰菌阴转率和治愈率均达到项目的要求。结论必须进一步加强农村和青壮年的肺结核病控制工作,有助于加快结核病的控制。     

Gender differences in relation to sputum submission and smear-positive pulmonary tuberculosis in Malawi.

OBJECTIVE: To examine gender differences in sputum submission and sputum smear positivity. METHODS: Laboratory registers in all diagnostic units in eight districts in Malawi were examined for the years 1995 and 1996. RESULTS: During a 12-month period (averaged between 1995 and 1996), 26,624 new TB suspects submitted sputum samples, 3282 of which (12.3%) were smear-positive. Significantly more males submitted sputum (52%) compared with females (48%), and significantly more males (53%) were smear-positive compared with females (47%, P < 0.05). Rates of sputum submission per 100,000 adults were also significantly higher for males (1203) than females (1032). CONCLUSION: In Malawi, fewer females are submitting sputum samples and are being diagnosed with smear-positive TB compared with males.     

惠州市外来人口涂阳肺结核患者治疗效果分析

目的　总结外来人口肺结核病的管理及治疗效果。为将外来人口纳入区域结核病控制规划提供科学依据。方法 对门诊登记确诊的外来人口肺结核病人提供免费诊治和实施DOTS管理。结果 2 0 0 1— 2 0 0 2年对 4 5 0例暂住半年以上的外来人口的涂阳肺结核患者进行治疗。初治涂阳治愈率 90 .9% ,复治涂阳治愈率 85 %,接近常住户口肺结核病人的治疗效果。结论 加强外来人口结核病的管治力度 ,进一步完善各项管理措施 ,可取到与常住人口同样的治疗效果。