Abstract
Microbiological findings at diagnosis and at the end of treatment are relevant for evaluating tuberculosis (TB) treatment programmes. The objectives of this study were to describe the microbiological findings at diagnosis and at the end of treatment in pulmonary and extrapulmonary TB patients treated under programme conditions in Italy. The study was a prospective monitoring activity based on the collection of standard recording and reporting forms from a representative sample of Italian TB Units. The forms with individual data were reviewed and analysed on a quarterly basis, 9 months after enrolment. The complete bacteriological profile of patients was analysed at diagnosis and at the completion of treatment. Individual data on 992 patients were analysed. At diagnosis 320 (32.2%) of cases were pulmonary sputum smear positive, 361 (36.4%) pulmonary smear negative or not done and 311 (33.4%) extrapulmonary; 424 (42.7%) of all TB cases were culture confirmed at diagnosis (368, 50.2%, of pulmonary cases); 575 (84.4%) of pulmonary cases had a culture done at diagnosis and 156 (22.9%) at the end of treatment (p< 0.001); 572 (84%) had a sputum smear done at diagnosis and 164 (24.1%) at the end of treatment (p< 0.001). Although the rate of bacteriologically confirmed cases is similar to that of other European countries, the bacteriological confirmation at diagnosis and, particularly, at the end of treatment, is sub-optimal. The importance of further disseminating national guidelines among physicians managing TB is emphasized, in order to achieve a higher proportion of TB cases bacteriologically confirmed at diagnosis and monitored at the end of treatment.
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References
Clancy L, Rieder HL, Enarson DA, Spinaci S. Tuberculosis elimination in the countries of Europe and other industrialized countries. Eur Respir J 1991; 4: 1988-1995.
Enarson DA. The international union against tuberculosis and lung disease model. National tuberculosis programmes. Tuberc Lung Dis 1995; 76: 95-99.
World Health Organization. WHO Framework for Effective Tuberculosis Control. WHO, Geneva. 1994; WHO/TB/94.179: 1-13.
World Health Organization, Tuberculosis Unit, Division of Communicable Diseases. Tuberculosis Surveillance and MonitoringGeneva. 1991; WHO/TB/91.163: 1-18.
World Health Organization. Managing Tuberculosis at District Level. A Training Course. Module A5: Monitoring Treatment. Geneva. 1994: 1-68.
Rieder HL, Watson JM, Raviglione MC, et al. Surveillance of tuberculosis in Europe. Eur Respir J 1996; 9: 1097-1104.
Veen J, Raviglione MC, Rieder HL, et al. Standardised treatment outcome monitoring in Europe. Recommendations of Working Group of WHO and IUATLD. Eur Respir J 1998; 12: 505-510.
Migliori GB, Ambrosetti M, Besozzi G, Casali L, Raviglione MC & the National AIPO ‘Tuberculosis’ Study Group. Prospective multicentre study on the evaluation of antituberculosis treatment results in Italy: Comparison of the culture-versus the smear-based methods. Eur Respir J 1999; 13: 900-903.
Ambrosetti M, Besozzi G, Codecasa LR, et al. & the National AIPO “Tuberculosis” Study Group. The Italian AIPOstudy on tuberculosis treatment results, Report 1995. Monaldi Arch Chest Dis 1999; 54(1): 49-54.
World Health Organization. Global Tuberculosis Control. WHO Report 1999. Communicable Diseases, World Health Organization, Geneva 1999. WHO/TB/CPC99.259: 1-179.
Migliori GB, Di Pisa G, Capecchi V, et al. Protocol for Tuberculosis Control in Italy. Monograph of Rass Pat App Resp. Pacini Editor, Pisa, Italy, 1995: 1-86.
Migliori GB, Casali L, Nardini S, Spanevello A, Besozzi G, Faravelli B & the National AIPO Tuberculosis Study Group. Evaluation of the impact of guidelines on tuberculosis control in Italy. Monaldi Arch Chest Dis 1996; 51(3): 204-209.
World Health Organization. Treatment of Tuberculosis. Guidelines for National Programmes. World Health Organization, Geneva, 1997. WHO/TB/97.220: 1-77.
Migliori GB, Raviglione MC. Specific problems in developing areas of the world: Central and Eastern Europe. In: Davies PDO (ed), Clinical Tuberculosis. London: Chapman & Hall, 1998: 643-660.
EuroTB (CESES/KNCV) & the National Coordinators for Tuberculosis Surveillance in the WHO European Region. Surveillance of tuberculosis in Europe. Report on the feasibility study (1996-1997). Tuberculosis cases notified in 1995. October 1997.
Veen J, Kalisvaart NA. Index Tuberculosis 1995, The Netherlands. Royal Netherlands Tuberculosis Association (KNCV), The Hague, 1996: 1-100.
Migliori GB, Ambrosetti M, Besozzi G, et al. & the AIPO Tuberculosis Study Group. Cost-comparison of different management policies for tuberculosis patients in Italy. Bull World Health Organ 1999; 77: 467-476.
Migliori GB, Ambrosetti M, Fattorini L, et al. & the SMIRA (Italian Multicentre Study on Resistance to Antituberculosis drugs) Study Group. Surveillance of anti-tuberculosis drug resistance: Results of the 1998/1999 proficiency testing in Italy. Int J Tuberc Lung Dis 2000; 4(10): 1-7.
Migliori GB, Ambrosetti M, Besozzi G, et al. & AIPO Study Group ‘Tuberculosis’. Cohort analysis of antituberculosis treatment results in Italy. Rapporti ISTISAN 1997; 97/1: 142.
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Migliori, G., Ambrosetti, M., Besozzi, G. et al. Microbiological confirmation of tuberculosis cases at diagnosis and at the end of treatment in Italy. Eur J Epidemiol 16, 719–724 (2000). https://doi.org/10.1023/A:1026798000966
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DOI: https://doi.org/10.1023/A:1026798000966