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201-PA10 Neurofibrome cervical simulant une adénite tuberculeuse calcifiée
32
Tubercle and Lung Disease: Supplement 2
179-PAl0 Mortality of tuberculosis in hospitalized patients today Skodric, V., Sekulic, S., Radosavljevic, 7"., Vukcevic, M., PavlovicPopovic, Z. Institute for Pulmonary Disease and TB of Serbia, Clinical Centre of Serbia, Belgrade, Yugoslavia
Tuberculosis (TB) is still one of the greatest public health tragedies of our time in spite of WHO intervention and control measures. We analyzed medical records of 2788 tuberculous patients (1858 males and 930 females) at the Institute for Pulmonary Disease and TB of Serbia during the last five years (1990 to 1994). Thirty-six patients (1.3%) died of TB, aged from 23 to 85 yrs. The highest mortality was found at the middle age range of 41-60 yrs (54%). The most patients who died of TB (28 pts; 77.7%) had some predisposing conditions. The most frequent predisposing conditions were: alcoholism in pts (11%), malignancy (stable state), diabetes, prolonged corticosteroid treatment in 5 pts (17.8%) each and mental illness in 1 pt (7.1%). On hospital admission 31 pts (86.1%) were in a very bad general condition, almost cachectic. Chest X-ray showed extensive bilateral destruction with cavities in all patients (36). Thirty-one pts (86.1%) didn't ask for medical help even though they felt symptoms of illness for 3-12 months. The direct cause of death was active tuberculosis in 31 pts (86.1%), while in 5 pts (13.9%) apoplexy was the direct cause of death, although TB was present. The conclusion of this study is that the tuberculosis tragedy of our time is a result of asking for medical treatment too late.
181-PAl0 Diagnostic errors in bacteriologically negative tuberculosis Leowski, J., Miller, M. Dept. Epidemiology, TB Institute, Warsaw, Poland
A cohort of 7429 patients diagnosed in 1992 as having bacteriologically negative pulmonary tuberculosis has been followed up for 12 months and their management and treatment outcome compared with bacteriologically positive tuberculosis patients. During this 12 months period 343 patients, i.e. 4.6%, died, of which 26.8% due to tuberculosis and 73.2% due to other causes. The proportion of deaths was two times lower than in the group of bacteriologically positive patients. More than half of the patients were treated longer than 6 months with 4 most potent drugs (HRZS) in the intensive phase. The presence of co-existing diseases, like alcoholism, diabetes, diseases of digestive tract, were two times less prevalent than in bacteriologically positive patients. According to radiological criteria of treatment outcome full disappearance of X-ray changes was noted in 15% of cases, significant improvement in 40%, lack of improvement or deterioration in 5.5%. Unexpected finding was that in 8.5% of cases there was no radiological follow-up at all. At the end of 12 months of clinical follow-up of bacteriologically negative patients, tuberculosis as final diagnosis was confirmed in 95% of cases. The remaining 5% were other pulmonary diseases
and 2/3 of them were diagnosed as lung cancer. This findings, however, should be further analysed in depth, particularly the group of patients (15%) in whom X-ray changes disappeared completely and the other group of 5.5% where deteriorations in X-ray were observed.
192-PA10 Patient's and doctor's delay in Greek TB patients Politis, G., Toumbis, M., Zarmbis, G., Anestopoulou, J., Manteou, M., Petrakis, K. Chest Diseases Hospital of Athens, 'Sotiria', Athens, Greece
The interval between the appearance of the first symptoms referable to tuberculosis and the patient's first seeking medical advice (patient's delay) and the interval between the patient' s first visit and diagnosis of tuberculosis (doctor's delay), are crucial factors influencing the risk of transmission of tuberculosis. The aim of the present study was to estimate the combined patient's and doctor's delay time in bacteriologically confirmed pulmonary tuberculosis patients. Two hundred and ten patients admitted to our hospital and proved to be smear or culture positive for tuberculous bacilli were studied. One hundred and thirty nine of them were male and 71 were female. The mean age was 55.7 years (range 18-78 years).
Results: The combined average patient's and doctor's delay was 3.5 months. The mean delay in months (D) as a function of several factors is shown in the following table. Age 20-30
D 3.5
Profession Governmental clerks Private clerks Labourers Farmers
31-40
3.2
41-50 51~50 61-70
3.0 3.8 4.0
Age 20-30 31-40 41-50 51-60 61-70
D 2.7
Education High
D 2.7
3.3
Intermediate
3.3
3.9 4.1
Elementary Illiteracy
3.9 4.1
D
Symptoms
D
D
I-Iemoptysis Fever Chest pain Dyspnea Cough
1.8 1.9 4.1 4.8 4.9
Doctor' s Speciality Pneumonologist Other
3.5 3.2 3.0 3.8 4.0
2.6 4.4
Conclusions: The mean combined patient's and doctor's delay was 3.5 months. Low educated and industrial or agriculture workers, without threatening symptoms, showed the highest patient's delay. Pneumonologists showed almost the half delay in comparison with the other doctors' delay. 201-PAl0 Neurofibrome cervical simulant une ad6nite tuberculeuse calcifi~e Toppet, M., Frickx, Ch., Hanquinet, S., Heimann, P. HOpital Universitaire Des Enfants Reine Fabiola (Huderf), Bruxelles, Belgique
Un jeune garqon angolais ~g6 de 6 ans est examin6 en consultation de prdiatrie ~t I'HUDERF en Janvier 1995. I1 prrsente une adrnopathie cervicale postrrieure droite
Abstracts
de 2 cm. de diam~tre, apparue il y a 2 ans et 20 plages hyperpigment6es dissimin6es sur l'ensemble du corps. Parmi les examens r6alisds: - l'6chographie cervicale est en faveur d'ad6nopathies calcifides. - la biologic est normale de m~me que la RX thorax. - l ' I D 2 u - RT23 est positive: 12 III (sensitine intracellulaire 12 IV). Devant la possibilit6 d'une ad6nite tuberculeuse, une ex6r~se biopsie est r6alis6e qui confirmera le n6urofibrome cervical et la Maladie de Von Recklinghausen d6jh pr6sente chez le p6re.
Conclusion: Cette observation ddmontre 1- l'intdr~t de la biopsie darts la confirmation ou non du diagnostic d'ad6nite tubereuleuse avant l'instauration du traitement 2- que la Neurofibromatose doit faire partie des diagnostics diff6rentiels des ad6nopathies cervicales persistantes surtout si l'anamn~se familiale ou l'examen physique sont suggestifs de l'affection.
33
quelle population de diabdtique est sujette fr6quemment la tuberculose pulmonaire. Nous avons pu noter que le diab6tique n'avait pas de profil tuberculeux particulier, et clue la tuberculose pulmonaire commune 6tait plus fr6quente chez les diab6tiques insulino-d6pendants.
226-PA10
Health service delay in diagnosis
Kangangi, J., Kibuga, D. National Leprosy~Tuberculosis Programme, Kenya
This study was carried out in Embu in Eastern Province. A group of 125 smear positive pulmonary TB patients were recruited for this study between June 1994 and March 1995. Embu District in Kenya has a good climate, rich in agriculture, has good communication network, and literacy rate is estimated over 50% of population. The health facilities are well distributed. Methods used: 1. Interviews with patients 2. Examination of patients record cards
214-PA10 Mycobacterium tuberculosis does not necessarily mean disease? Leesik, H., Kriiiiner, A., Reintam, M.-A., Kummik, T. Tartu University Lung Hospital, RIIA STR. 167, EE2400 Tartu, Estonia
The aim of the study was to evaluate the so-called random findings of mycobacteria in pulmonary clinic. In two years 36 cases with diagnosis other than tuberculosis, but with established findings of mycobacteria either bacteriologically (26) or bacterioscopically (10) were analyzed. Finding of mycobacteria using culture media was confirmed from 22 sputum and 4 bronchial secretion samples the diagnosis being bronchial asthma in 7, pneumonia in 10 and chronic bronchitis in 9 cases. The susceptibility of mycobacteria to drugs was as follows: to INH and RFM in 81%, SM - 69, EMB - 93, ETH - 83%. During the subsequent year none of the patients contracted tuberculosis. Bacterioscopically mycobacteria were found in lymph node and lung biopsy specimens, in bronchial aspirate, in sputum of 6 patients with carcinoma and 4 with pneumonia. The patients had no clinical, radiological or morphological traces of lung tuberculosis. It can be presumed that avirulent forms of Mycobacterium tuberculosis exist.
219-PAl0
Tubereulose pulmonaire et diab6te
Snouber, A., Guermaz, M., Mened, N. Oran, Algeria
A travers cette 6tude retrospective, les auteurs ont collig6 80 cas de tuberculose pulmonaire commune associes au diab6te, ayant 6t6 hospitalises durant la p6riode 88-94. L'objectif de notre 6tude est de ddterminer le profil radio-clinique, bact6riologique et 6volutif de la tuberculose pulmonaire chez le diabdtique, ainsi que de savoir
I assessed the duration of time between when the patient presented to a health facility with symptom of cough and the time when diagnosis of tuberculosis was made. The proportions of patients corresponding to various months of delay in diagnosis is shown below:1 month (m) = 5.3%, 2 m = 15.8%, 3 m = 15.8%, 4 m = 10.5%, 5 m = 15.8%, 8 m = 26.3%, 1 yr = 10.5%.
Recommendations: General health staff education must be intensified by all means.
229-PA10 Morphology of tuberculous nodules in bronchobiopsies Zdravko Kosjerina, Vesna Kosjerina-OYtrid. Institute for Lung Diseases and Tuberculosis, Sremska Kamenica, Yugoslavia
The paper analyses morphologic characteristics of 53 tuberculous nodules in 31 bronchobiopsies obtained from 31 patients with tuberculosis (19 males and 12 females, aged 48.4 yrs averagely). The shortest distance from the basal membrane to the closer edge of a tuberculous nodule was 0 microns (a nodule touches the basal membrane) while the longest one was 1.165 microns. An average distance of a nodule from the basal membrane was 184.9 microns and a standard deviation was 266.5. Localisation of tuberculoid nodules inside the bronchial structure was the following: (a) in the internal third of the lamina propria - 18 nodules; (b) in central third of the lamina propria 4 nodules; (c) in the external third of the lamina propria - 14 nodules; (d) immediately under the basal membrane - 15 nodules; (e) between bronchial glands - 2 nodules. The border of tuberculous nodules to the periphery was clear in 3 nodules, relatively clear in 13 and unclear in 37 nodules.
Tubercle and Lung Disease: Supplement 2
179-PAl0 Mortality of tuberculosis in hospitalized patients today Skodric, V., Sekulic, S., Radosavljevic, 7"., Vukcevic, M., PavlovicPopovic, Z. Institute for Pulmonary Disease and TB of Serbia, Clinical Centre of Serbia, Belgrade, Yugoslavia
Tuberculosis (TB) is still one of the greatest public health tragedies of our time in spite of WHO intervention and control measures. We analyzed medical records of 2788 tuberculous patients (1858 males and 930 females) at the Institute for Pulmonary Disease and TB of Serbia during the last five years (1990 to 1994). Thirty-six patients (1.3%) died of TB, aged from 23 to 85 yrs. The highest mortality was found at the middle age range of 41-60 yrs (54%). The most patients who died of TB (28 pts; 77.7%) had some predisposing conditions. The most frequent predisposing conditions were: alcoholism in pts (11%), malignancy (stable state), diabetes, prolonged corticosteroid treatment in 5 pts (17.8%) each and mental illness in 1 pt (7.1%). On hospital admission 31 pts (86.1%) were in a very bad general condition, almost cachectic. Chest X-ray showed extensive bilateral destruction with cavities in all patients (36). Thirty-one pts (86.1%) didn't ask for medical help even though they felt symptoms of illness for 3-12 months. The direct cause of death was active tuberculosis in 31 pts (86.1%), while in 5 pts (13.9%) apoplexy was the direct cause of death, although TB was present. The conclusion of this study is that the tuberculosis tragedy of our time is a result of asking for medical treatment too late.
181-PAl0 Diagnostic errors in bacteriologically negative tuberculosis Leowski, J., Miller, M. Dept. Epidemiology, TB Institute, Warsaw, Poland
A cohort of 7429 patients diagnosed in 1992 as having bacteriologically negative pulmonary tuberculosis has been followed up for 12 months and their management and treatment outcome compared with bacteriologically positive tuberculosis patients. During this 12 months period 343 patients, i.e. 4.6%, died, of which 26.8% due to tuberculosis and 73.2% due to other causes. The proportion of deaths was two times lower than in the group of bacteriologically positive patients. More than half of the patients were treated longer than 6 months with 4 most potent drugs (HRZS) in the intensive phase. The presence of co-existing diseases, like alcoholism, diabetes, diseases of digestive tract, were two times less prevalent than in bacteriologically positive patients. According to radiological criteria of treatment outcome full disappearance of X-ray changes was noted in 15% of cases, significant improvement in 40%, lack of improvement or deterioration in 5.5%. Unexpected finding was that in 8.5% of cases there was no radiological follow-up at all. At the end of 12 months of clinical follow-up of bacteriologically negative patients, tuberculosis as final diagnosis was confirmed in 95% of cases. The remaining 5% were other pulmonary diseases
and 2/3 of them were diagnosed as lung cancer. This findings, however, should be further analysed in depth, particularly the group of patients (15%) in whom X-ray changes disappeared completely and the other group of 5.5% where deteriorations in X-ray were observed.
192-PA10 Patient's and doctor's delay in Greek TB patients Politis, G., Toumbis, M., Zarmbis, G., Anestopoulou, J., Manteou, M., Petrakis, K. Chest Diseases Hospital of Athens, 'Sotiria', Athens, Greece
The interval between the appearance of the first symptoms referable to tuberculosis and the patient's first seeking medical advice (patient's delay) and the interval between the patient' s first visit and diagnosis of tuberculosis (doctor's delay), are crucial factors influencing the risk of transmission of tuberculosis. The aim of the present study was to estimate the combined patient's and doctor's delay time in bacteriologically confirmed pulmonary tuberculosis patients. Two hundred and ten patients admitted to our hospital and proved to be smear or culture positive for tuberculous bacilli were studied. One hundred and thirty nine of them were male and 71 were female. The mean age was 55.7 years (range 18-78 years).
Results: The combined average patient's and doctor's delay was 3.5 months. The mean delay in months (D) as a function of several factors is shown in the following table. Age 20-30
D 3.5
Profession Governmental clerks Private clerks Labourers Farmers
31-40
3.2
41-50 51~50 61-70
3.0 3.8 4.0
Age 20-30 31-40 41-50 51-60 61-70
D 2.7
Education High
D 2.7
3.3
Intermediate
3.3
3.9 4.1
Elementary Illiteracy
3.9 4.1
D
Symptoms
D
D
I-Iemoptysis Fever Chest pain Dyspnea Cough
1.8 1.9 4.1 4.8 4.9
Doctor' s Speciality Pneumonologist Other
3.5 3.2 3.0 3.8 4.0
2.6 4.4
Conclusions: The mean combined patient's and doctor's delay was 3.5 months. Low educated and industrial or agriculture workers, without threatening symptoms, showed the highest patient's delay. Pneumonologists showed almost the half delay in comparison with the other doctors' delay. 201-PAl0 Neurofibrome cervical simulant une ad6nite tuberculeuse calcifi~e Toppet, M., Frickx, Ch., Hanquinet, S., Heimann, P. HOpital Universitaire Des Enfants Reine Fabiola (Huderf), Bruxelles, Belgique
Un jeune garqon angolais ~g6 de 6 ans est examin6 en consultation de prdiatrie ~t I'HUDERF en Janvier 1995. I1 prrsente une adrnopathie cervicale postrrieure droite
Abstracts
de 2 cm. de diam~tre, apparue il y a 2 ans et 20 plages hyperpigment6es dissimin6es sur l'ensemble du corps. Parmi les examens r6alisds: - l'6chographie cervicale est en faveur d'ad6nopathies calcifides. - la biologic est normale de m~me que la RX thorax. - l ' I D 2 u - RT23 est positive: 12 III (sensitine intracellulaire 12 IV). Devant la possibilit6 d'une ad6nite tuberculeuse, une ex6r~se biopsie est r6alis6e qui confirmera le n6urofibrome cervical et la Maladie de Von Recklinghausen d6jh pr6sente chez le p6re.
Conclusion: Cette observation ddmontre 1- l'intdr~t de la biopsie darts la confirmation ou non du diagnostic d'ad6nite tubereuleuse avant l'instauration du traitement 2- que la Neurofibromatose doit faire partie des diagnostics diff6rentiels des ad6nopathies cervicales persistantes surtout si l'anamn~se familiale ou l'examen physique sont suggestifs de l'affection.
33
quelle population de diabdtique est sujette fr6quemment la tuberculose pulmonaire. Nous avons pu noter que le diab6tique n'avait pas de profil tuberculeux particulier, et clue la tuberculose pulmonaire commune 6tait plus fr6quente chez les diab6tiques insulino-d6pendants.
226-PA10
Health service delay in diagnosis
Kangangi, J., Kibuga, D. National Leprosy~Tuberculosis Programme, Kenya
This study was carried out in Embu in Eastern Province. A group of 125 smear positive pulmonary TB patients were recruited for this study between June 1994 and March 1995. Embu District in Kenya has a good climate, rich in agriculture, has good communication network, and literacy rate is estimated over 50% of population. The health facilities are well distributed. Methods used: 1. Interviews with patients 2. Examination of patients record cards
214-PA10 Mycobacterium tuberculosis does not necessarily mean disease? Leesik, H., Kriiiiner, A., Reintam, M.-A., Kummik, T. Tartu University Lung Hospital, RIIA STR. 167, EE2400 Tartu, Estonia
The aim of the study was to evaluate the so-called random findings of mycobacteria in pulmonary clinic. In two years 36 cases with diagnosis other than tuberculosis, but with established findings of mycobacteria either bacteriologically (26) or bacterioscopically (10) were analyzed. Finding of mycobacteria using culture media was confirmed from 22 sputum and 4 bronchial secretion samples the diagnosis being bronchial asthma in 7, pneumonia in 10 and chronic bronchitis in 9 cases. The susceptibility of mycobacteria to drugs was as follows: to INH and RFM in 81%, SM - 69, EMB - 93, ETH - 83%. During the subsequent year none of the patients contracted tuberculosis. Bacterioscopically mycobacteria were found in lymph node and lung biopsy specimens, in bronchial aspirate, in sputum of 6 patients with carcinoma and 4 with pneumonia. The patients had no clinical, radiological or morphological traces of lung tuberculosis. It can be presumed that avirulent forms of Mycobacterium tuberculosis exist.
219-PAl0
Tubereulose pulmonaire et diab6te
Snouber, A., Guermaz, M., Mened, N. Oran, Algeria
A travers cette 6tude retrospective, les auteurs ont collig6 80 cas de tuberculose pulmonaire commune associes au diab6te, ayant 6t6 hospitalises durant la p6riode 88-94. L'objectif de notre 6tude est de ddterminer le profil radio-clinique, bact6riologique et 6volutif de la tuberculose pulmonaire chez le diabdtique, ainsi que de savoir
I assessed the duration of time between when the patient presented to a health facility with symptom of cough and the time when diagnosis of tuberculosis was made. The proportions of patients corresponding to various months of delay in diagnosis is shown below:1 month (m) = 5.3%, 2 m = 15.8%, 3 m = 15.8%, 4 m = 10.5%, 5 m = 15.8%, 8 m = 26.3%, 1 yr = 10.5%.
Recommendations: General health staff education must be intensified by all means.
229-PA10 Morphology of tuberculous nodules in bronchobiopsies Zdravko Kosjerina, Vesna Kosjerina-OYtrid. Institute for Lung Diseases and Tuberculosis, Sremska Kamenica, Yugoslavia
The paper analyses morphologic characteristics of 53 tuberculous nodules in 31 bronchobiopsies obtained from 31 patients with tuberculosis (19 males and 12 females, aged 48.4 yrs averagely). The shortest distance from the basal membrane to the closer edge of a tuberculous nodule was 0 microns (a nodule touches the basal membrane) while the longest one was 1.165 microns. An average distance of a nodule from the basal membrane was 184.9 microns and a standard deviation was 266.5. Localisation of tuberculoid nodules inside the bronchial structure was the following: (a) in the internal third of the lamina propria - 18 nodules; (b) in central third of the lamina propria 4 nodules; (c) in the external third of the lamina propria - 14 nodules; (d) immediately under the basal membrane - 15 nodules; (e) between bronchial glands - 2 nodules. The border of tuberculous nodules to the periphery was clear in 3 nodules, relatively clear in 13 and unclear in 37 nodules.