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Resistance of mycobacterium tuberculosis (M.TB) in Berlin 1987–1993
40
Tubercle and Lung Disease: Supplement
incidence of tuberculosis (TB) (> 800/100,000), these patients are often investigated for TB. The aim of this prospective study was to determine whether there is a seasonal difference in the number of children diagnosed with TB. Over a 10 year period (l/11/83 - 31/10/93) the data of all children < 13 years of age with positive cultures for M. tuberculosis (M.tb) were collected. The date of submission of the first positive culture from each child was used to determine the season of presentation. In addition the season of presentation of all children with TB meningitis (TBM), diagnosed prospectively during the same 10 years, was assessed. 1660 cultures of M.tb were obtained from I204 children. TBM was diagnosed in 297 children during the same period. Seasonal rates are shown in table
as a percentage of the number of patients.
;I * p < 0.001 (Chi square for goodness of fit) Conclusion: Culture rate of M.tb was significantly
higher during spring than during the other seasons. This is supported by the same trend in children with TBM. We speculate that more TB infections occurs during winter which then present with disease in spring.
146 A DECADE OF EXPERIENCE WITH M. TUBERCULOSIS (M. TB) CULTURE FROM CHILDREN Schaaf, H. S., Beyers, N., Nel, E. D., Gie, R. P., Scott, F., Donald, P.R.; Tygerberg Hospital and the University of Stellenbosch, P. 0. Box 19063, Tygerberg, 7505, RSA
Many children with suspected tuberculosis (TB) are seen at Tygerberg Hospital (TB incidence in drainage area >800/100 000). Cultures for M. tb are generally positive in only + 25 % of children with TB. This study looked at the gender and age distribution of children with confirmed TB and determined the origin of M. tb cultures. The data of children < 13 years with positive cultures for M. tb were prospectively collected from l/11/83 - 31/10/93. LGwenstein-Jensen culture medium (LJM) was replaced by a radiometric method (BactecR) in 1990. 1660 M. tb cultures were collected from 1204 children. 342 children had more than 1 specimen culture positive for M. tb while 90 (7.5 %) had positive cultures from more than 1 source. Boys: girls ratio was 53 % : 47 % . Age distribution Source
All Gastric aspir Sputum CSF Bronchi aspir Pleural fluid Urine
and origin of specimens: Specimens Patients n= n= 1660 1298 96 52 54 26 17
1204 983 79 47 43 23 16
% in age groups (yr) o-2
52 58 16 40 67 26 6
2-5
29 29 14 47 14 35 44
>5
19 l3 70 l3 19 39 50
Mean culture time with BactecR (25.3 + 12.3 days) was significantly less than with LJM (65 f 21 days) (p < 0.0001). Conclusions: 1. In children with suspected TB a variety of specimens should be submitted for culture of M.tb. 2. In 7.5 % of children M.tb was cultured from > 1 source. 3. BactecR significantly reduced the mean culture time.
147 RESISTANCE OF MYCOBACTERIUM TUBERCULOSIS (M.TB) IN BERLIN 1987-1993 Schaberg, T., Gloger, G., Mauch, H.. Lode, H.; Lungenklinik Heckeshorn, Zum Heckeshorn 33, D-14109 Berlin, Germany
Introduction
and rationale of study: Resistance of M.tb is an increasing problem worldwide. Since no public health data are available for urban populations in Germany, we investigated resistance in our hospitalized patients since 1987. Methods: Evaluation of clinical data and susceptibility results (break point technique/proportional method) for isoniazid (H), streptomycin (S), rifampin (R), pyrizinamide (Z), prothionamide (P) and ethambutol (E) from 1218 patients with smear positive pulmonary tuberculosis. Results: Since 1987 there is an increasing percentage of single drug resistance (SDR) in our patients (table 1). Drugs involved mostly are H (56 %) and S (23 %). Multidrug resistance (2 2 drugs) (MDR) remains stable since 1990. More than 50% of MDR are due to H and S resistance. Table 1 1987
1988
1989
1990
1991
1992
1993
21 Risk factors
foreign
born
for SDR and MDR have been a status as
(60%)
and
previous
treatment
(37 %).
Conclusion:
In a great urban population in Germany we found increasing and relatively high rates of M.tb. resistance since 1987.
148 A PILOT STUDY OF DIAGNOSTIC & PROGNOSTIC VALUE OF SERUM MYCOBACTERIAL ANTIGEN (A 60) IgG & ADENOSINE DEAMINASE IN PULMONARY TUBERCULOSIS Sharaf El Din, M., Hassan, F., El Mougy, F., Hussein, I. 6 Ahmed Fouad Nessim St., Nasr City, Cairo. Egypt
The study was conducted on 22 active pulmonary T. B. cases and 10 matched control subjects. All patients hat sputum positive for acid fast bacilli. They were subjected to full clinical examination including chest X-ray. Blood samples were taken at admission and at one and two months following the start of anti TB therapy for routine analysis as well as serum ADA and A60 IgG. The results of this study revealed that on admission, mean ADA level 37.07 k 2.49 U/L was significantly higher than the control group 15.88 & 0.97 U/L. The value of ADA on admission was significantly higher than at one and two months after treatment. This implies the importance of ADA as a predictor for successful treatment. Serum IgG to A60 presented significantly higher values after 2 months of treatment than its level on admission. When a cutoff value of 200 units was chosen, 36.6 % of patients were found to be positive for A60 IgG on admission, while the figure increased to 68.2 % after 2 months of treatment. This may signify a role for A60 IgG on long term follow up as a predictor of immunological response to TB infection. No correlation was found between either ADA or A60 IgG and type or extent of radiological findings nor with extent of tuberculin activity.
Tubercle and Lung Disease: Supplement
incidence of tuberculosis (TB) (> 800/100,000), these patients are often investigated for TB. The aim of this prospective study was to determine whether there is a seasonal difference in the number of children diagnosed with TB. Over a 10 year period (l/11/83 - 31/10/93) the data of all children < 13 years of age with positive cultures for M. tuberculosis (M.tb) were collected. The date of submission of the first positive culture from each child was used to determine the season of presentation. In addition the season of presentation of all children with TB meningitis (TBM), diagnosed prospectively during the same 10 years, was assessed. 1660 cultures of M.tb were obtained from I204 children. TBM was diagnosed in 297 children during the same period. Seasonal rates are shown in table
as a percentage of the number of patients.
;I * p < 0.001 (Chi square for goodness of fit) Conclusion: Culture rate of M.tb was significantly
higher during spring than during the other seasons. This is supported by the same trend in children with TBM. We speculate that more TB infections occurs during winter which then present with disease in spring.
146 A DECADE OF EXPERIENCE WITH M. TUBERCULOSIS (M. TB) CULTURE FROM CHILDREN Schaaf, H. S., Beyers, N., Nel, E. D., Gie, R. P., Scott, F., Donald, P.R.; Tygerberg Hospital and the University of Stellenbosch, P. 0. Box 19063, Tygerberg, 7505, RSA
Many children with suspected tuberculosis (TB) are seen at Tygerberg Hospital (TB incidence in drainage area >800/100 000). Cultures for M. tb are generally positive in only + 25 % of children with TB. This study looked at the gender and age distribution of children with confirmed TB and determined the origin of M. tb cultures. The data of children < 13 years with positive cultures for M. tb were prospectively collected from l/11/83 - 31/10/93. LGwenstein-Jensen culture medium (LJM) was replaced by a radiometric method (BactecR) in 1990. 1660 M. tb cultures were collected from 1204 children. 342 children had more than 1 specimen culture positive for M. tb while 90 (7.5 %) had positive cultures from more than 1 source. Boys: girls ratio was 53 % : 47 % . Age distribution Source
All Gastric aspir Sputum CSF Bronchi aspir Pleural fluid Urine
and origin of specimens: Specimens Patients n= n= 1660 1298 96 52 54 26 17
1204 983 79 47 43 23 16
% in age groups (yr) o-2
52 58 16 40 67 26 6
2-5
29 29 14 47 14 35 44
>5
19 l3 70 l3 19 39 50
Mean culture time with BactecR (25.3 + 12.3 days) was significantly less than with LJM (65 f 21 days) (p < 0.0001). Conclusions: 1. In children with suspected TB a variety of specimens should be submitted for culture of M.tb. 2. In 7.5 % of children M.tb was cultured from > 1 source. 3. BactecR significantly reduced the mean culture time.
147 RESISTANCE OF MYCOBACTERIUM TUBERCULOSIS (M.TB) IN BERLIN 1987-1993 Schaberg, T., Gloger, G., Mauch, H.. Lode, H.; Lungenklinik Heckeshorn, Zum Heckeshorn 33, D-14109 Berlin, Germany
Introduction
and rationale of study: Resistance of M.tb is an increasing problem worldwide. Since no public health data are available for urban populations in Germany, we investigated resistance in our hospitalized patients since 1987. Methods: Evaluation of clinical data and susceptibility results (break point technique/proportional method) for isoniazid (H), streptomycin (S), rifampin (R), pyrizinamide (Z), prothionamide (P) and ethambutol (E) from 1218 patients with smear positive pulmonary tuberculosis. Results: Since 1987 there is an increasing percentage of single drug resistance (SDR) in our patients (table 1). Drugs involved mostly are H (56 %) and S (23 %). Multidrug resistance (2 2 drugs) (MDR) remains stable since 1990. More than 50% of MDR are due to H and S resistance. Table 1 1987
1988
1989
1990
1991
1992
1993
21 Risk factors
foreign
born
for SDR and MDR have been a status as
(60%)
and
previous
treatment
(37 %).
Conclusion:
In a great urban population in Germany we found increasing and relatively high rates of M.tb. resistance since 1987.
148 A PILOT STUDY OF DIAGNOSTIC & PROGNOSTIC VALUE OF SERUM MYCOBACTERIAL ANTIGEN (A 60) IgG & ADENOSINE DEAMINASE IN PULMONARY TUBERCULOSIS Sharaf El Din, M., Hassan, F., El Mougy, F., Hussein, I. 6 Ahmed Fouad Nessim St., Nasr City, Cairo. Egypt
The study was conducted on 22 active pulmonary T. B. cases and 10 matched control subjects. All patients hat sputum positive for acid fast bacilli. They were subjected to full clinical examination including chest X-ray. Blood samples were taken at admission and at one and two months following the start of anti TB therapy for routine analysis as well as serum ADA and A60 IgG. The results of this study revealed that on admission, mean ADA level 37.07 k 2.49 U/L was significantly higher than the control group 15.88 & 0.97 U/L. The value of ADA on admission was significantly higher than at one and two months after treatment. This implies the importance of ADA as a predictor for successful treatment. Serum IgG to A60 presented significantly higher values after 2 months of treatment than its level on admission. When a cutoff value of 200 units was chosen, 36.6 % of patients were found to be positive for A60 IgG on admission, while the figure increased to 68.2 % after 2 months of treatment. This may signify a role for A60 IgG on long term follow up as a predictor of immunological response to TB infection. No correlation was found between either ADA or A60 IgG and type or extent of radiological findings nor with extent of tuberculin activity.