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Przegl Epidemiol. 2000;54(1-2):9-24.
[Tuberculosis in Poland and the world at the beginning of the third millennium]

[Article in Polish]

Szczuka I.

Zaklad Epidemiologii i Organizacji Walki z Gruzlica, Instytutu Gruzlicy i Chorob Pluc.

BACKGROUND: Tuberculosis has been a major public health problem in Poland for many decades. OBJECTIVE: The aim of this investigation was to evaluated incidence, prevalence and mortality from TB in Poland in 1998 and to examine trends of TB incidence. METHODS: Individual date on tuberculosis cases reported to National TB Register and date of prevalence and mortality from TB were analysed. RESULTS: The paper presents the epidemiological situation of TB in Poland in 1998. The year of 1998 was the fifth consecutive year of decline at TB incidence after previous years (1991-1993) of increase. In 1998 there were 13,302 newly registered TB cases, of which 1,476 were relapses. The incidence was 34.4 per 100,000 population, (30.6 were the new cases and 3.8 relapses). Relapses represented 11.1% of all new registered cases. The incidence in 1998 was 4.7% lower than in 1997, but the rate of decline was smaller than in previous year (9.3%). Among the total number of newly registered cases there were 7,501 cases (19.4 per 100,000) bacteriologically confirmed, of which 4,090 cases were sputum smear positive. The proportion of bacteriologically culture positive cases was 56.4% and of sputum smear positive -30.7% which is rather low, but similar to previous years. In view of sufficient network of laboratory services this low proportion of bacteriological confirmation of diagnosis may indicate low quality of bacteriological examinations. In 96.2% of cases the diagnosis was respiratory tuberculosis. Low proportion (3.8%) of non respiratory tuberculosis, which continuous for many years, may indicate inadequacies in diagnosis and registration of this form of disease. The incidence of tuberculosis increases with age, from 1.5 in children up to 67.3 among 65 and older. The proportion of cases in the age group 20-44 years is still high (38.1%). The incidence in men (47.4) is two times higher than in women (22.1), and in rural population higher than in urban--35.6 and 33.7 respectively. The prevalence of tuberculosis at the end of 1998 was 39.5 (15,284 cases), of which 56.2% were bacteriologically confirmed cases (8,593 cases). In the latter group there were 256 cases bacteriologically positive for longer than one year, and 541 cases resistant to at least 1 drug. The proportion of resistant cases (6.3%) is similar to previous years and does not seem to influence the overall effectiveness of chemotherapy. CONCLUSIONS: In recent years incidence of TB in Poland decreased. The incidence of tuberculosis in Poland was about 2 times higher than the average for E.U. countries, but lower than in other Eastern European countries. The distance between Poland and countries with lowest incidence is estimated at 25-30 years.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11076140&dopt=Abstract

Mem Inst Oswaldo Cruz. 2002 Dec;97(8):1097-9. Epub 2003 Jan 20.
Kinetics of T cell-activation molecules in response to Mycobacterium tuberculosis antigens.

Antas PR, Oliveira EB, Milagres AS, Franken KC, Ottenhoff TH, Klatser P, Sarno EN, Sampaio EP.

Laboratorio de Hanseniase, Instituto Oswaldo Cruz, Fiocruz, 21045-900 Rio de Janeiro, RJ, Brasil. pzuquioc.fiocruz.br

The phenotypic features acquired subsequent to antigen-specific stimulation in vitro were evaluated by means of the kinetic expressions of CD69 and CD25 activation molecules on T lymphocytes and assayed by flow cytometry in response to PPD, Ag85B, and ferritin in PPD-positive healthy control individuals. In response to PHA, CD69 staining on both CD4+ and CD8+ T cells became initially marked after 4 h, peaked at 24 h, and quickly decreased after 120 h. For CD25, a latter expression was detected around 8 h, having increased after 96 h. As expected, the response rate to the mycobacterial antigens was much lower than that to the mitogen. Positive staining was high after 96 h for CD25 and after 24 h for CD69. CD69 expression was significantly enhanced (p < 0.05) on CD8+ as compared to CD4+ T cells. High levels were also found between 96-120 h. Regarding Ag85B, CD25+ cells were mostly CD4+ instead of CD8+ T cells. Moreover, in response to ferritin, a lower CD25 expression was noted. The present data will allow further characterization of the immune response to new mycobacterial-specific antigens and their evaluation for possible inclusion in developing new diagnostic techniques for tuberculosis as well in a new vaccine to prevent the disease.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12563472&dopt=Abstract

Am J Med Sci. 2002 Nov;324(5):285-7.
Chronic plasma cell pneumonia in a patient with long-standing HIV infection.

Foreman MG, Flenaugh E, Stringer HG, Hewan-Lowe K.

Section of Pulmonary and Critical Care, Morehouse School of Medicine, Atlanta, Georgia 30310, USA. foremasm.edu

Chronic bibasilar alveolar infiltrates existed for more than 2 years in a 25-year-old woman infected with HIV for more than a decade. Bronchoscopically, there were copious, purulent secretions that grew methicillin-resistant Staphylococcus aureus (MRSA). Transbronchial biopsy specimens demonstrated plasma cell interstitial pneumonia (PCIP). Focal, transient radiographic improvement occurred after antistaphylococcal antimicrobial therapy. With recurrent and progressive symptoms, sustained clinical and radiographic improvement did not occur until corticosteroid therapy was instituted with tuberculosis chemoprophylaxis. Persistent antigenic stimulation in immunosuppressed patients causes PCIP. In this instance, the stimulus is MRSA. The previous model and support for this theory is Pneumocystis carinii. There is good experimental reason for a plasma cell response in persons infected with HIV. To our knowledge, this is the first case of chronic plasma cell interstitial pneumonia caused by indolent MRSA infection.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12449452&dopt=Abstract

Przegl Epidemiol. 2000;54(1-2):25-33.
[Infectious diseases in Poland in 1998]

[Article in Polish]

Naruszewicz-Lesiuk D, Czarkowski MP.

Zaklad Epidemiologii, Panstwowego Zakladu Higieny, Warszawa.

Epidemiological situation of majority of infectious diseases in Poland was in 1998 consecutively improved. Decrease of incidence of infectious hepatitis type A and B was noted as well as of tuberculosis and sexually transmitted diseases. Percentage of deaths caused by infectious diseases decreased to 0.6%. Sustaining of such positive trends will require first of all continuation of preventive immunizations at present level, improvement of laboratory diagnoses, but also an improvement of identification of diseased and infected peoples and also notification of cases.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11076141&dopt=Abstract

Rev Clin Esp. 2000 Aug;200(8):412-9.
Diagnostic efficacy of the study of contacts of tuberculosis patients in a high prevalence urban area.

[Article in Spanish]

Solsona J, Cayla JA, Bedia M, Mata C, Claveria J; Grupo de trabajo para estudio de contactos de Ciutat Vella, Barcelona.

Centro de Prevencion y Control de la Tuberculosis Dr. Lluis Saye, Barcelona.

BACKGROUND: The investigation of contacts (CI) is a main objective for the control of tuberculosis (TB) after therapeutic compliance. The present study was planned to determine the diagnostic effectiveness and degree of CI implementation as well as risk factors to generate new cases in a high prevalence area (163/10(5)). PATIENTS AND METHODS: An analysis was made of the available data of CI in the Barcelona district of Ciutat Vella in 1997 and 1998. The odds ratio (OR) was calculated as a measure of the association with infection and tuberculosis disease with a 95% confidence interval (CI) by logistic regression. RESULTS: CI was made in 65.2% of patients and 100% of tuberculin-positive children. Thirty patients were diagnosed among 858 contacts of 135 tuberculosis patients (3.49%) and 8 among 318 contacts of 64 primoinfected children aged less than 15 years (2.51%). Prevalence of tuberculosis infection was 51.51% and 46.85%, respectively. The characteristics of the index case associated with new patients were drug abuse (OR: 11.16; CI: 3.0-40.9) and to be prisoner (OR: 18.7; CI: 1.5-232.9). No influence was detected regarding sputum acid-fast smears and degree of closeness except for contacts aged less than 20 years. CONCLUSIONS: CI is cost-effective in this area of high prevalence and should be performed in every TB case although priority groups are prisoners and/or drug abusers and contacts aged less than 20 years. The implementation of CI can be improved in our setting.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11076177&dopt=Abstract

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