- Email: [email protected]
454-PA10 Tuberculin conversion among health care workers in a general hospital of Rio de Janeiro, Brasil. Preliminary results
Abstracts
tered" isolates but this proportion may rise as the study continues since the period of collection is short relative to the incubation period of TB.
Conclusions: A substantial amount of TB seen in the gold mines is caused by ongoing transmission. An infectious source (or sources) at an individual mine over the past few years has contributed significantly to the current burden of disease. Establishing the relative importance of ongoing transmission rather than reactivation of disease imported with migrant labour will allow more rational control measures to be developed.
471-PAl0
Genetic diversity among M. tuberculosis
in Zambia Bruce, M., Kambashi B., de Haas, P., Kahenya, G., GodfreyFaussett, P. Zambart Project, UTH, Lusaka and RIVM, Bilthoven
Background: DNA fingerprinting of M. tuberculosis has enhanced our understanding of the epidemiology of tuberculosis in Europe and the USA. In countries with a high prevalence of TB and little immigration, particular isolates may be expected to predominate. In order to explore the potential of DNA fingerprinting to address epidemiological questions in such a situation we have studied the diversity of strains within and between individuals in Zambia.
442-PA10
51
Tuberculosis morbidity in Lithuania
Gaidamoniene, D., Butkiene, P., Daniene, J., Slapkauskaite, D. Centre of Pulmonology and Tuberculosis, Vilnius, Lithuania
Till 1986 TB morbidity [MB] had a tendency to decrease, but from 1989 there was a progressive increase. If in 1989 morbidity was 37.4 per 100000 population, then in 1994 it had already increased up to 63.0 per 100000 population. TB MB in 1994 among adults, teenagers and children was 67.0/25.7/16.8 per 100000 according to the age groups. MB among countryside population is always higher than among the city population, and MB is twice higher among males than females. According to the age, the highest MB during year 1994 was: 30 to 39 years - 72.4, 40 to 49 years - 100.9, 50 to 59 years of age - 84.2 per 100000 population° The most commonly met TB form is TB of respiratory system. In 1994 it made 88.1%, while extrapulmonal TB was 11.9%. New TB cases of respiratory system in structure of clinical forms were as follows: infiltrative TB made 53.6%, disseminated lung TB 20.5%, focus forms 14.4%. New sputum positive cases among adults were 56.2%. Prevalence [Pr] of all TB forms in 1994 made 240.1 per 100000 population. Pr was 314.1 among adults, 39.8 among teenagers and 31.5 among children per 100000 population. Mortality from TB - 11.2 per 100000 population. Moreover, it was more common in the countryside than in the city.
Methods: DNA fingerprints were made in Lusaka using standard methods from three groups of specimens: I. Multiple individual colonies picked from the periphery of primary sputum isolates and subcultured; II. Multiple isolates from one episode in an individual; III. Isolates from different individuals. Fingerprints from groups I and II were compared in sets by visual inspection. Those from group III were scanned into a computer and analysed using GelCompar Software. Identical and nearly identical matches were reinspected visually to confirm the validity of the software's matching.
454-PA10 Tuberculin conversion among health care workers in a general hospital of Rio de Janeiro, Brasil. Preliminary results Bodchat, N., Muz~ de Souza, G., Cravo, R., Mellow, F., Viana, A., Nunes, Z., Oliveira, 0., Kritski, A. Rio de Janeiro, Brazil
Objective: To assess the tuberculin test (TT) conversion rate in a general hospital of Rio de Janeiro.
Methods: In February 1994 the two step TT was pro-
isolates - only one set showed mixed infection. II. 173 isolates from 83 patients were fingerprinted - one set showed mixed infection. III. Isolates from 115 individuals were fingerprinted. Three quarters of the isolates fall within one large family (which may represent a clade). However, two thirds of isolates are unique with no identical match among those so far examined. Almost all the isolates have had more than six copies of IS6110.
posed to the HCWs in our hospital. PPDRT23/Serum Institute- Denmark were performed by Ministry of Health trained nurse practitioners. Number of HCWs = 432:221 or 51% reactors, 1 lost and 210 nonreactors. In the last group, one week later another test was done. Booster phenomena occurred in 7 or 5% and 79 or 37% were lost. Those who failed to achieve at least 6 mm of increment over the initial reading sere considered as negatives ones, n = 124 or 59%. Among those 80 or 65% were retested 12 to 14 months thereafter.
Conclusions: It is surprisingly rare to find mixed infections within an individual in Zambia, despite the high prevalence of both TB and HIV. DNA fingerprinting with IS6110 is a robust tool and the copy number is high enough to draw reliable conclusions about relatedness in Zambia. Although there is much less heterogeneity between individuals than in Europe or the USA, it is still possible to define small clusters of identical fingerprints that may represent ongoing transmission.
Results: 74 or 92% of HCWs have persistent negative tests and 6 or 8% showed the conversion of TT, i.e. 10 mm of increase over the highest previous reading. The relationships between conversion and HCWs grouped by age (< 50 and > 50), occupation (contact with Tb patients x administrative personnel), work settings (wards and offices with Tb patients x administrative and services areas), community exposure to Tb (household contacts x no household contacts) were
Results: I. 293 colonies were picked from 81 primary
52
Tubercle and Lung Disease: Supplement 2
analysed by the Fischer's Test with p values of 0.007, 0.6, 1.0, and 1.0 respectively.
066-PAl0 A retrospective analysis in cases with primary pulmonary tuberculosis
Conclusions: From these preliminary results we can conclude that the conversion rate among HCWs in our hospital is higher than in the general population.
Ekim, N.N., Levent, E., Ki~smez, C. Gazi University School of Medicine, Turkey
TUBERCULOSIS:
TUBERCULOSIS
IN
CHILDREN
046-PAl0 Peculiarities of clinical symptoms, character of immune changes in children suffering from tuberculosis with clinical signs of acquired immunodeficiency syndrome Kostromina, V.P., Derkach, E. V., Rushchak, V.A. Institute of Tuberculosis & Pulmonology, Kiev, Ukraine
Fifty six children, suffering from local tuberculosis forms with clinical signs of acquired immunodeficiency syndrome (AIDS), residing in radioactive polluted areas were studied. As a control 61 children suffering from tuberculosis without clinical signs of immunodeficiency were studied. In children with AIDS weakness, tiredness and decrease of appetite was registered 3.5 times and hyperreactivity to tuberculin 1.5 times more frequently than in control group. Complicated tuberculosis process (atelectasis, dissemination, destruction) was registered in patients with AIDS 2.1 times more often than in control group, 30% of children have undulating character of tuberculosis course. In children with AIDS severe changes of cellular immunity were noted.
054-PA10 Radiographic pulmonary changes in children with tuberculosis Koncul, L, Milkovid D., Raos, M. Specijalna bolnica za bolesti di~nog sustava djece i mlade~i, Srebrnjak 100, Zagreb, Croatia
Chest radiographs were analyzed in relation to the nature of changes, localization, age and to the interrelationships of all these parameters, in 204 patients suffering of a recently detected tuberculosis. The patients have been treated for three and a half years and increase in the number of cases has been influenced by the war, refugees and displaced persons. Their age varies from 0 to 14 years (SD 6,4 + 4,2 years). The most frequent radiographic change is lymphadenopathy, found in 172 (84,2%) patients, and more frequent in the younger age group from 0 to 4 years (p < .0001) and in the right hilomediastinal area (p < .0001). Parenchymal changes were identified in 125 (61,2%) patients, also more frequent at an earlier age (p < .03), and more often found on the right than on the left side (p < .0001). Other forms of the disease (atelectasis, cavern, tbc miliaris) were less frequent, with the exception of pleuritis that affected 13 (6,3%) patients. The author stresses the importance of chest radiography in diagnosing and keeping a record of tuberculosis of children.
Primary pulmonary tuberculosis is still a major problem in developing countries including Turkey. In this study, 66 cases with primary pulmonary tuberculosis diagnosed between 1983-1993 were reviewed retrospectively. There were 36 (54,6%) female patients. The age range was 7 months-18 years (6,61 + 0,54 years). 92% were 12 years old or less. A history of close contact was elicited in 27 patients (40,9%). Family screening was the most efficient way to detect patients. 37 (56%) patients had been vaccinated previously with BCG.60 (93,7%) patients had a positive PPD response to 5TU. 65,1% of patients had symptoms, the most frequent being cough (59,1%) and night sweats (36,4%). Mycobacteriology was carried out in only 16 (24%) patients. Bacteriologic confirmation was achieved in only one patient. Chest radiographs were reviewed in all cases. Lymphadenopathy occurred in 98,48% of patients, with hilar (72,24%) and combined hilar-paratracheal (19,49%) the commonest findings. The majority of patients were treated with isoniazid and rifampin, with a minority receiving pyrazinamide or streptomycin in the initial intensive phase. 2 patients had adverse reactions to their drugs. Response to therapy was excellent in all cases.
103-PAl0 Tuberculosis and mycobacteriosis in children in the Czech Republic Kfepela, K. Pediatric Clinic of the Institute for Postgraduate Medical Studies, Prague, Czech Republic
The falling incidence of tuberculosis in children in the Czech Republic and the occurrence of BCG osteoarticular complications in connection with the Russian BCG vaccine used from the year 1980 were reasons for interruption of vaccination in newborns in three regions of the Czech Republic in the years 1986 and 1989. During the period 1988-1993 the incidence of tuberculosis in children was rising to a three times higher value (from 0,9 to 2,7/100,000 children). In nonvaccinated children a relatively high number of cervical lymphadenitis due to Myco. avium was observed (3,4/ 100,000 children). Such cases were not observed in vaccinated children. In the year 1993 a one year old non-vaccinated child died of generalized Tb. From the year 1994 the mass vaccination of newborns in the Czech Republic was renewed, but the Russian vaccine was changed for a German vaccine.
162-PAl0 Immigration and tuberculosis (TB) in young children, San Diego County, CA Kenyon, T.A*., Driver, C., Schneider, E., Daley, M., Valway, S.E., Haas, E., Moser, K., Onorato, I.M. Centers for Disease Control and Prevention, Atlanta, GA; San Diego County Department of Health Services, San Digeo, CA, USA
Between 1985 and 1993, TB cases in children 19 years
tered" isolates but this proportion may rise as the study continues since the period of collection is short relative to the incubation period of TB.
Conclusions: A substantial amount of TB seen in the gold mines is caused by ongoing transmission. An infectious source (or sources) at an individual mine over the past few years has contributed significantly to the current burden of disease. Establishing the relative importance of ongoing transmission rather than reactivation of disease imported with migrant labour will allow more rational control measures to be developed.
471-PAl0
Genetic diversity among M. tuberculosis
in Zambia Bruce, M., Kambashi B., de Haas, P., Kahenya, G., GodfreyFaussett, P. Zambart Project, UTH, Lusaka and RIVM, Bilthoven
Background: DNA fingerprinting of M. tuberculosis has enhanced our understanding of the epidemiology of tuberculosis in Europe and the USA. In countries with a high prevalence of TB and little immigration, particular isolates may be expected to predominate. In order to explore the potential of DNA fingerprinting to address epidemiological questions in such a situation we have studied the diversity of strains within and between individuals in Zambia.
442-PA10
51
Tuberculosis morbidity in Lithuania
Gaidamoniene, D., Butkiene, P., Daniene, J., Slapkauskaite, D. Centre of Pulmonology and Tuberculosis, Vilnius, Lithuania
Till 1986 TB morbidity [MB] had a tendency to decrease, but from 1989 there was a progressive increase. If in 1989 morbidity was 37.4 per 100000 population, then in 1994 it had already increased up to 63.0 per 100000 population. TB MB in 1994 among adults, teenagers and children was 67.0/25.7/16.8 per 100000 according to the age groups. MB among countryside population is always higher than among the city population, and MB is twice higher among males than females. According to the age, the highest MB during year 1994 was: 30 to 39 years - 72.4, 40 to 49 years - 100.9, 50 to 59 years of age - 84.2 per 100000 population° The most commonly met TB form is TB of respiratory system. In 1994 it made 88.1%, while extrapulmonal TB was 11.9%. New TB cases of respiratory system in structure of clinical forms were as follows: infiltrative TB made 53.6%, disseminated lung TB 20.5%, focus forms 14.4%. New sputum positive cases among adults were 56.2%. Prevalence [Pr] of all TB forms in 1994 made 240.1 per 100000 population. Pr was 314.1 among adults, 39.8 among teenagers and 31.5 among children per 100000 population. Mortality from TB - 11.2 per 100000 population. Moreover, it was more common in the countryside than in the city.
Methods: DNA fingerprints were made in Lusaka using standard methods from three groups of specimens: I. Multiple individual colonies picked from the periphery of primary sputum isolates and subcultured; II. Multiple isolates from one episode in an individual; III. Isolates from different individuals. Fingerprints from groups I and II were compared in sets by visual inspection. Those from group III were scanned into a computer and analysed using GelCompar Software. Identical and nearly identical matches were reinspected visually to confirm the validity of the software's matching.
454-PA10 Tuberculin conversion among health care workers in a general hospital of Rio de Janeiro, Brasil. Preliminary results Bodchat, N., Muz~ de Souza, G., Cravo, R., Mellow, F., Viana, A., Nunes, Z., Oliveira, 0., Kritski, A. Rio de Janeiro, Brazil
Objective: To assess the tuberculin test (TT) conversion rate in a general hospital of Rio de Janeiro.
Methods: In February 1994 the two step TT was pro-
isolates - only one set showed mixed infection. II. 173 isolates from 83 patients were fingerprinted - one set showed mixed infection. III. Isolates from 115 individuals were fingerprinted. Three quarters of the isolates fall within one large family (which may represent a clade). However, two thirds of isolates are unique with no identical match among those so far examined. Almost all the isolates have had more than six copies of IS6110.
posed to the HCWs in our hospital. PPDRT23/Serum Institute- Denmark were performed by Ministry of Health trained nurse practitioners. Number of HCWs = 432:221 or 51% reactors, 1 lost and 210 nonreactors. In the last group, one week later another test was done. Booster phenomena occurred in 7 or 5% and 79 or 37% were lost. Those who failed to achieve at least 6 mm of increment over the initial reading sere considered as negatives ones, n = 124 or 59%. Among those 80 or 65% were retested 12 to 14 months thereafter.
Conclusions: It is surprisingly rare to find mixed infections within an individual in Zambia, despite the high prevalence of both TB and HIV. DNA fingerprinting with IS6110 is a robust tool and the copy number is high enough to draw reliable conclusions about relatedness in Zambia. Although there is much less heterogeneity between individuals than in Europe or the USA, it is still possible to define small clusters of identical fingerprints that may represent ongoing transmission.
Results: 74 or 92% of HCWs have persistent negative tests and 6 or 8% showed the conversion of TT, i.e. 10 mm of increase over the highest previous reading. The relationships between conversion and HCWs grouped by age (< 50 and > 50), occupation (contact with Tb patients x administrative personnel), work settings (wards and offices with Tb patients x administrative and services areas), community exposure to Tb (household contacts x no household contacts) were
Results: I. 293 colonies were picked from 81 primary
52
Tubercle and Lung Disease: Supplement 2
analysed by the Fischer's Test with p values of 0.007, 0.6, 1.0, and 1.0 respectively.
066-PAl0 A retrospective analysis in cases with primary pulmonary tuberculosis
Conclusions: From these preliminary results we can conclude that the conversion rate among HCWs in our hospital is higher than in the general population.
Ekim, N.N., Levent, E., Ki~smez, C. Gazi University School of Medicine, Turkey
TUBERCULOSIS:
TUBERCULOSIS
IN
CHILDREN
046-PAl0 Peculiarities of clinical symptoms, character of immune changes in children suffering from tuberculosis with clinical signs of acquired immunodeficiency syndrome Kostromina, V.P., Derkach, E. V., Rushchak, V.A. Institute of Tuberculosis & Pulmonology, Kiev, Ukraine
Fifty six children, suffering from local tuberculosis forms with clinical signs of acquired immunodeficiency syndrome (AIDS), residing in radioactive polluted areas were studied. As a control 61 children suffering from tuberculosis without clinical signs of immunodeficiency were studied. In children with AIDS weakness, tiredness and decrease of appetite was registered 3.5 times and hyperreactivity to tuberculin 1.5 times more frequently than in control group. Complicated tuberculosis process (atelectasis, dissemination, destruction) was registered in patients with AIDS 2.1 times more often than in control group, 30% of children have undulating character of tuberculosis course. In children with AIDS severe changes of cellular immunity were noted.
054-PA10 Radiographic pulmonary changes in children with tuberculosis Koncul, L, Milkovid D., Raos, M. Specijalna bolnica za bolesti di~nog sustava djece i mlade~i, Srebrnjak 100, Zagreb, Croatia
Chest radiographs were analyzed in relation to the nature of changes, localization, age and to the interrelationships of all these parameters, in 204 patients suffering of a recently detected tuberculosis. The patients have been treated for three and a half years and increase in the number of cases has been influenced by the war, refugees and displaced persons. Their age varies from 0 to 14 years (SD 6,4 + 4,2 years). The most frequent radiographic change is lymphadenopathy, found in 172 (84,2%) patients, and more frequent in the younger age group from 0 to 4 years (p < .0001) and in the right hilomediastinal area (p < .0001). Parenchymal changes were identified in 125 (61,2%) patients, also more frequent at an earlier age (p < .03), and more often found on the right than on the left side (p < .0001). Other forms of the disease (atelectasis, cavern, tbc miliaris) were less frequent, with the exception of pleuritis that affected 13 (6,3%) patients. The author stresses the importance of chest radiography in diagnosing and keeping a record of tuberculosis of children.
Primary pulmonary tuberculosis is still a major problem in developing countries including Turkey. In this study, 66 cases with primary pulmonary tuberculosis diagnosed between 1983-1993 were reviewed retrospectively. There were 36 (54,6%) female patients. The age range was 7 months-18 years (6,61 + 0,54 years). 92% were 12 years old or less. A history of close contact was elicited in 27 patients (40,9%). Family screening was the most efficient way to detect patients. 37 (56%) patients had been vaccinated previously with BCG.60 (93,7%) patients had a positive PPD response to 5TU. 65,1% of patients had symptoms, the most frequent being cough (59,1%) and night sweats (36,4%). Mycobacteriology was carried out in only 16 (24%) patients. Bacteriologic confirmation was achieved in only one patient. Chest radiographs were reviewed in all cases. Lymphadenopathy occurred in 98,48% of patients, with hilar (72,24%) and combined hilar-paratracheal (19,49%) the commonest findings. The majority of patients were treated with isoniazid and rifampin, with a minority receiving pyrazinamide or streptomycin in the initial intensive phase. 2 patients had adverse reactions to their drugs. Response to therapy was excellent in all cases.
103-PAl0 Tuberculosis and mycobacteriosis in children in the Czech Republic Kfepela, K. Pediatric Clinic of the Institute for Postgraduate Medical Studies, Prague, Czech Republic
The falling incidence of tuberculosis in children in the Czech Republic and the occurrence of BCG osteoarticular complications in connection with the Russian BCG vaccine used from the year 1980 were reasons for interruption of vaccination in newborns in three regions of the Czech Republic in the years 1986 and 1989. During the period 1988-1993 the incidence of tuberculosis in children was rising to a three times higher value (from 0,9 to 2,7/100,000 children). In nonvaccinated children a relatively high number of cervical lymphadenitis due to Myco. avium was observed (3,4/ 100,000 children). Such cases were not observed in vaccinated children. In the year 1993 a one year old non-vaccinated child died of generalized Tb. From the year 1994 the mass vaccination of newborns in the Czech Republic was renewed, but the Russian vaccine was changed for a German vaccine.
162-PAl0 Immigration and tuberculosis (TB) in young children, San Diego County, CA Kenyon, T.A*., Driver, C., Schneider, E., Daley, M., Valway, S.E., Haas, E., Moser, K., Onorato, I.M. Centers for Disease Control and Prevention, Atlanta, GA; San Diego County Department of Health Services, San Digeo, CA, USA
Between 1985 and 1993, TB cases in children 19 years