Analysis of tuberculosis surveillance in Hungary in 2000.

SETTING: Hungary, Central Europe, with a population of 10.3 million living in 20 administrative districts (19 counties and the capital). OBJECTIVE: To summarize the results of the first year of the revised National Tuberculosis Surveillance System. DESIGN: Retrospective survey of the National Tuberculosis Surveillance Center (NTSC) database. METHODS: Analysis of data on all tuberculosis cases reported to the NTSC in 2000. Drug susceptibility results were evaluated in line with WHO and IUATLD definitions. RESULTS: During 2000, a total of 3598 patients with tuberculosis were reported. Only 40% of these were bacteriologically confirmed. Although susceptibility testing has been required for previously untreated culture-positive cases, only 801 (67.8% of the bacteriologically confirmed cases) were tested in 2000. Drug resistance was detected in 10.7% of previously untreated and in 23.5% of previously treated patients. Multidrug-resistant (MDR) cases were not common: only 1.5% of the isolates from previously untreated patients and 4.9% of those from previously treated patients were MDR. CONCLUSIONS: The results suggest that the NTSC should work towards increasing the numbers of cases that are bacteriologically confirmed. In addition, some form of surveillance system should be instituted to ensure that mandatory susceptibility testing is performed on all isolates from previously untreated tuberculosis patients.

[The role of bacteriology in the treatment of tuberculosis; the Hungarian program]. / A bakteriológia szerepe a tbc gyógyszeres kezelésében; hazai vonatkozások.

A positive result of the bacteriological examination of Mycobacterium tuberculosis is signal to start treatment. The response to antituberculosis chemotherapy in patients with positive bacteriology is best evaluated by repeated examinations. The recommendation of the Hungarian National Tuberculosis Programme for the initial intensive phase of chemotherapy of previously untreated patients is based on the frequency of primoresistance determined by the National Reference Laboratory. The treatment of multidrug resistant tuberculosis can be supported by the result of previous susceptibility test and/or by the outcome of multicenter validated Bactec 460 susceptibility test of second-line antimicrobial drugs. The presence of a mutation within a gen is predictive of rifampicin resistance of M. tuberculosis. The results are available within 48 h. 92.4% of rifampicin resistant and nearly 100% of pyrazinamid resistant isolates in the Reference Laboratory were resistant to isoniazid. On the other hand streptomycin resistant strains were susceptible to amikacin in a rate of 38:1. Some rifampicin resistant strains are susceptible to rifabutin. The Reference Laboratory observed among the first that some ofloxacin resistant strains are susceptible to ciprofloxacin. It was the first which demonstrated effectivity of amikacin in the treatment of pulmonary tuberculosis. It was drawn attention to the importance of the PAS infusion therapy of multidrug resistant tuberculosis cases by observing bacteriological conversion.

Drug-resistant tuberculosis in Budapest.

SETTING: Sixteen districts of Budapest, Hungary. OBJECTIVE: To determine the frequency of primary and secondary drug resistance, and to recommend treatment regimens. DESIGN: A retrospective survey. METHODS: Mycobacterium tuberculosis isolates were collected from 264 newly diagnosed and 147 previously treated patients. All strains were tested against isoniazid (INH), rifampicin (RIF), streptomycin (SM) and ethambutol (EMB) using the proportion method. Bacteriologic examinations were performed in the Diagnostic Laboratory of the Koranyi National Institute for Tuberculosis and Pulmonology in Budapest. RESULTS: Primary resistance to INH alone was 4%, to SM alone 2%, to RIF alone 0.4%, to INH and SM 1%, and to INH, RIF, SM and EMB 0.4%. Of the isolates of 78 relapse cases, six (8%) were resistant to INH alone, one (1%) to INH and RIF, two (3%) to INH, RIF, SM and EMB. Of the isolates of 69 patients notified with active tuberculosis for over a year, 51 (74%) were susceptible to the drugs tested. CONCLUSION: Based on the level of primary drug resistance as well as on the resistance pattern of relapse cases, it is recommended to start the treatment of newly detected and relapse cases with four drugs. The high rate of chronic cases with susceptible strains can be explained by poor compliance. To prevent development of resistant cases and to achieve good compliance, it is necessary to apply direct observation of treatment in all types of patients.

Detection of mycobacteria in sputum smears prepared by cytocentrifugation and sedimentation.

The efficacy of sedimentation combined with cytocentrifugation of sputa was examined by preparing smears for the detection of mycobacteria. The detection of acid-fast bacilli from sputum sediment by cytocentrifugation yielded 32 smears positive for acid-fast bacilli, out of which in 26 cases better results were obtained than by the conventional method. More bacilli were found in 20 cases and on 6 occasions solely the cytospin method was positive. The differences in the number of bacilli were 100-200-fold in 5 cases and 10-fold in 12 paired cases. The technique applied is suitable for making culture and smear from the same sediment. The sedimentation combined with cytocentrifugation increases the effectiveness of the detection of acid-fast bacilli in smears.

[Which patients are dying of tuberculosis in the 90-s?]. / Kik halnak meg tuberkulózisban a 90-es években?

Medical and social characteristics of 27 patients deceased in tuberculosis in the Korányi National Institute for Tuberculosis and Pulmonology, Budapest, were analysed and evaluated. M. tuberculosis strains sensitive to all antituberculotic drugs were isolated from all cases. Characteristics of patients: males over 40 years of age (17 cases), single (9 cases), alcoholics (16 cases) who were transferred from another hospital (13 cases). All patients had pulmonary tuberculosis, in 3 cases together with extrapulmonary lesions. Sputum direct smear examination revealed acid-fast bacteria in 9 cases. There were 8 relapses. It is proposed to consider possibility of tuberculosis in the presence of the above mentioned "risk factors".

Bulk staining of sputum by the Ziehl-Neelsen method.

A trial of the Ziehl-Neelsen staining method employing bulk decolorization, rinsing and counter staining yielded reliable results. Of 110 patients who proved to be positive by direct microscopy, cross-contamination could not be proved in any. The advantage of the mass method is its economy.

Effect of chlorhexidine gluconate on the survival of acid fast bacteria.

Mycobacterium and Nocardia species were examined for survival after exposure to chlorhexidine gluconate. In clinical samples M. smegmatis, M. phlei, M. marinum, M. gordonae, M. scrofulaceum, M. kansasii, M. chelonei complex, M. fortuitum, M. flavescens, M. avium, M. xenopi and Nocardia sp. survived pre-treatment with the agent. After exposure of saline suspensions of bacteria to chlorhexidine gluconate, M. smegmatis, M. phlei, M. marinum, M. gordonae, M. pellegrino, N. corallina, N. rubra and Rodochrous gordonae were not recovered, and M. fortuitum and N. asteroides grew poorly.