Department of Internal Medicine; Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
BMC Infect Dis. 2009 Dec 31;9:217. doi: 10.1186/1471-2334-9-217.
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.
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.
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%.
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.
自 20 世纪 90 年代以来，发达国家的结核病（TB）发病率有所下降，这反映了全球根据世界卫生组织（WHO）建议努力发现和治疗 TB。然而，TB 在工业化国家仍然是一个重要的公共卫生问题，其中很大一部分病例发生在来自高流行国家的人群中。本研究的目的是描述发病率低但移民率高的地区中 TB 患者的临床和社会特征及其结局。
这是一项基于计算机数据库的 4 年回顾性研究，并对瑞士日内瓦大学医院肺病科门诊患者的所有 TB 患者的病历进行了后续回顾。
共研究了 252 例患者（84%为外国人，25%为寻求庇护者），年龄 38 ± 19 岁（11%合并 HIV 感染）。158 例（63%）为肺内 TB（TBP），137 例（54%）为肺外 TB（TBE），43 例（17%）同时存在 TBP 和 TBE。TBP 中，59%的患者痰涂片（S）+/培养（C）+，37%的患者 S-/C+，4%的患者 S-/C-。吸烟与空洞性疾病显著相关。从症状出现到诊断的时间为 2.1 ± 3.1 个月。最初，10%的患者无症状；35%的患者无全身症状。尽管进行了系统的痰分析（诱导或自发），但仍有 38 例（占 TBP 的 24%）仅通过支气管镜检查才确诊 TBP。38 例（11%）患者因治疗相关副作用而需要改变治疗方案。210 例（83%）患者完成了治疗。42 例患者失访，原因包括：失败（n = 2；0.8%）、失访（n = 8；3%）、转院（n = 28；11%）和死亡（n = 4；1.6%）。复发率为 0.24/100 患者年。仅考虑 S+ TBP，成功率为 87%。
在我们的研究区域，TB 主要是年轻的外国出生人群的疾病。吸烟似乎是空洞性 TBP 的一个可能危险因素。诊断时间仍然较长。治疗依从性良好。S+ TBP 的成功率符合世界卫生组织的目标。
