Clinical presentation, demographics and outcome of Tuberculosis (TB) in a low incidence area: a 4-year study in Geneva, Switzerland
Clinical presentation, demographics and outcome of Tuberculosis (TB) in a low incidence area: a 4-year study in Geneva, Switzerland
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DOI：
10.1186/1471-2334-9-217
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发表时间：
2009-12-31
影响因子：
3.7
通讯作者：
Janssens, Jean-Paul
中科院分区：
文献类型：
--
作者：
Kherad, Omar;Herrmann, Francois R.;Janssens, Jean-Paul
背景：自20世纪90年代以来，发达国家的结核病发病率有所下降，这反映了世界范围内根据世卫组织的建议识别和治疗结核病的努力。然而，结核病在工业化国家仍然是一个重要的公共卫生问题，很高比例的病例发生在来自高流行国家的受试者中。本研究的目的是描述低发病率和高移民率地区结核病患者的临床和社会特征及其转归。方法：对瑞士日内瓦大学医院肺部疾病科门诊部的所有结核病患者进行为期4年的计算机数据库回顾性研究，并随后对所有患者的病历进行回顾。结果：252名患者(84%是外国人，25%是寻求庇护者)年龄38+/-19岁(11%合并感染HIV)。肺内(TBP)158例(63%)，肺外(TBE)137例(54%)，两者兼有43例(17%)。涂片(S)+/培养(C)+占59%，S-/C+占37%，S-/C-占4%。吸烟与空洞病显著相关，从出现症状到确诊的时间为2.1+/-3.1个月。最初，10%的人没有症状；35%的人没有一般症状。尽管进行了系统的痰分析(诱导的或自发的)，但只有38名受试者(占TBP的24%)通过支气管镜检查确认了TBP。38例(11%)出现了需要改变治疗的副作用。210例(83%)患者完成了治疗。42例随访失败，失败2例(0.8%)，违约8例(3%)，转出28例(11%)，死亡4例(1.6%)。复发率为0.24/百人年。单纯采用S+TBP治疗，治愈率为87%。结论：本地区结核病以外籍青年为主。吸烟可能是空洞性TBP的危险因素。确诊的时间仍然很长。治疗依从性令人满意。S+TBP的成功率在世卫组织的目标范围内。
Background: The incidence of tuberculosis (TB) in developed countries has decreased since the 1990s, reflecting worldwide efforts to identify and treat TB according to WHO recommendations. However TB remains an important public health problem in industrialized countries with a high proportion of cases occurring among subjects originating from high prevalence countries. The aim of this study was to describe clinical and social characteristics of patients with TB and their outcome in a low incidence area with a high immigration rate.Methods: Four-year retrospective study based on a computerized database and subsequent review of medical records of all patients with TB followed at the outpatient section of the Division of Pulmonary Diseases, Geneva University Hospital, Switzerland.Results: 252 patients (84% foreigners, 25% asylum seekers) aged 38 +/- 19 yrs were studied (11% co-infected with HIV). TB was intrapulmonary (TBP) in 158 cases (63%), extrapulmonary (TBE) in 137 (54%), and both in 43 cases (17%). TBP was smear (S)+/culture (C)+ in 59%, S-/C+ in 37%, S-/C- in 4%. Smoking was significantly associated with cavitary disease.Time from onset of symptoms to diagnosis was 2.1 +/- 3.1 months. Initially, 10% were asymptomatic; 35% had no general symptoms. Despite systematic sputum analysis (induced or spontaneous), TBP was confirmed only by bronchoscopy in 38 subjects (24% of TBP). Side effects requiring changes in treatment occurred in 38 cases (11%).Treatment was completed in 210 (83%) patients. In 42 cases, follow up was unsuccessful; causes were: failure (n = 2; 0.8%), defaulters (n = 8; 3%), transfer out (n = 28; 11%) and death (n = 4; 1.6%). Relapse rate was 0.24 per 100 patient-years. Considering S+ TBP only, success rate was 87%.Conclusion: TB in our area is predominantly a disease of young foreign-born subjects. Smoking appears as a possible risk factor for cavitary TBP. Time to diagnosis remains long. Compliance to treatment is satisfactory. Success rate for S+ TBP is within WHO objectives.