Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups - The Romanian Experience.

Introduction: Tuberculosis (TB) remains a global health challenge, requiring enhanced active case finding (ACF) through screening strategies. This study assesses the effectiveness of such an approach in locating TB cases among vulnerable groups, such as homeless persons, injecting drug users, those detained in prison, and people living in rural areas. Methods: The study focuses on socio-economic characteristics and TB detection rates across Romanian counties using modern techniques including computer-aided detection of lesions on chest X-ray and GeneXpert tests. Results: The results highlight the disproportionate burden of TB in vulnerable groups, by revealing significant differences in TB detection rates between regions. Notably, the TB detection rates among these vulnerable groups (250.85 per 100,000 population) are five times higher than the national incidence rate (46.1). Discussion: These findings underscore the imperative integration of ACF into National TB Program to provide customized and efficient solutions for diverse vulnerable groups, thereby informing crucial public health initiatives and interventions.

Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review.

Tuberculosis (TB) in kidney transplant (KT) recipients is an important opportunistic infection with higher incidence and prevalence than in the general population and is associated with important morbidity and mortality. We performed an extensive literature review of articles published between 1 January 2000 and 15 June 2022 to provide an evidence-based review of epidemiology, pathogenesis, diagnosis, treatment and outcomes of TB in KT recipients. We included all studies which reported epidemiological and/or outcome data regarding active TB in KT, and we approached the diagnostic and treatment challenges according to the current guidelines. Prevalence of active TB in KT recipients ranges between 0.3-15.2%. KT recipients with active TB could have a rejection rate up to 55.6%, a rate of graft loss that varies from 2.2% to 66.6% and a mortality rate up to 60%. Understanding the epidemiological risk, risk factors, transmission modalities, diagnosis and treatment challenges is critical for clinicians in providing an appropriate management for KT with TB. Among diagnostic challenges, which are at the same time associated with delay in management, the following should be considered: atypical clinical presentation, association with co-infections, decreased predictive values of screening tests, diverse radiological aspects and particular diagnostic methods. Regarding treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.

[Bilateral lung consolidations related to accidental exposure to parrots]. / Procese de condensare pulmonare legate de expunere accidentala la papagali.

The authors present the case of a 32 years male patient admitted for lung consolidations with bilateral extension tendency, associated to fever, respiratory failure and hepatic involvement, with a sudden onset two weeks after contact with apparently healthy parrots. Bronchiolo-alveolar lavage was suggestive for a hypersensitivity pneumonia, but the clinical evolution was good with antibiotics (macrolides, than doxycycline). Radiologic resolution was spectacular. Serum antibodies anti-ch. Psittaci were present in low titre, at the limit of significance. Final diagnosis was chlamydia psittaci pneumonia.

[Chronic management of COPD--results of a questionnaire for COPD patients]. / Managementul cronic al BPOC--rezultatele unui chestionar aplicat pacientilor.

AIM: evaluation of real ambulatory treatment followed by COPD patients. Eighty COPD patients were prospectively interviewed: 1 in stage I, 11 in stage II, 36 in stage III and 32 in stage IV. They were asked what medication they use as chronic ambulatory treatment and on what duration through one year, how many periodic check-ups they make. Most used medication is: short acting beta-2-agonists (63 pts), inhaled corticosteroids (40 pts), aminophylline (37 pts), long-acting theophylline (36 pts), and fixed combinations steroid + long-acting beta-2-agonist (35 pts). Eighteen patients had chronic prednisone treatment and 12 antibiotic prophylactic treatment. Only 31 patients had an anti-flu vaccine. There are no significant differences between treatment in rural and urban patients. Most patients follow the treatment for only 6 months a year. CONCLUSIONS: real ambulatory treatment in COPD is generally insufficient as duration and therapeutic principles, associating low frequency of periodic check-ups and a high frequency of exacerbations.