[Tuberculosis in the Bajo Deba area (Guipúzcoa, Spain) from 1995 to 2006]. / Tuberculosis en la comarca del Bajo Deba (Guipúzcoa) en el período 1995-2006.

BACKGROUND: Within the Multicenter Project on Tuberculosis Research performed in Spain in 1996-1997, the Bajo Deba Area reported the highest incidence of tuberculosis in the Basque Country. We analyzed the clinical and epidemiological characteristics of the tuberculosis population diagnosed in our area during the period of 1995 to 2006. METHODS: Ambispective, observational study. RESULTS: A total of 584 patients were diagnosed with tuberculosis. The disease affected the respiratory tract in 509 cases and other sites in 75 cases. The mean annual incidence rate of tuberculosis was 64.5 cases per 100 000 inhabitants (91.6 in 1995-1998; 34.9 in 2003-2006). The mean annual incidence rate of smear-positive patients was 20.7 cases per 100 000 inhabitants (33.8 in 1995-1998; 12.9 in 2003-2006). The 15 to 24-year-old group was the most highly affected during the period of 1995 to 1998 (mean annual incidence rate 199.4 cases per 100 000); in contrast, the > 75-year-old group was the most highly affected during the period of 2003 to 2006 (121.1 cases per 100 000 inhabitants). Fifty-three patients were co-infected by HIV (9%) (yearly mean of 11.6% in 1995-1998 and 7% in 2003-2006). Löwenstein culture was positive in 431 cases (73.8%). Resistance to isoniazid was detected in 1.4% out of a total of 287 strains tested, and multidrug resistance was not observed. Nine patients were immigrants (1.5%). Treatment completion was greater in our area (505 patients, 86.4%), as compared to that recorded in the Guipuzcoa province during the same period (1956 of 2525 patients, 77.5%) (P < .01). CONCLUSIONS: The Bajo Deba Area presented a high incidence of tuberculosis in the 1995 to 2006 period. Epidemiological trends showed a progressive decrease in the number of tuberculosis patients, with a shift from younger to older persons as the most highly affected age group. The impact of drug resistance and immigration was negligible on tuberculosis rates. The percentage of microbiologically confirmed cases was high. Treatment completion was satisfactory.

Tuberculosis en la comarca del Bajo Deba (Guipúzcoa) en el período 1995-2006 / Tuberculosis in the Bajo Deba Area (Guipúzcoa, Spain) from 1995 to 2006

Introducción. La comarca del Bajo Deba comunicó la incidencia más elevada de la comunidad autónoma vasca en el Proyecto Multicéntrico de Investigación en Tuberculosis (PMIT) realizado en España en 1996-1997. Analizamos las características clínicas y epidemiológicas de la población tuberculosa diagnosticada en nuestra comarca en el período en estudio. Métodos. Estudio ambispectivo observacional. Resultados. Se han diagnosticado 584 pacientes; 509 casos han sido de localización respiratoria, y 75 casos, extrarrespiratorios. La tasa media de incidencia por año ha sido 64,5 casos por 100.000 habitantes (91,6 en 1995-1998; 34,9 en 2003-2006). La tasa media de casos bacilíferos ha sido 20,7 por 100.000 y año (33,8 en 1995-1998; 12,9 en 2003-2006). El grupo etario más afectado en el cuatrienio 1995-1998 fue el de 15-24 años (tasa de incidencia media de 199,4 casos por 100.000 y por año); en 2003-2006 lo ha sido el de mayores de 75 años (121,1 casos por 100.000 y por año). Se hallaban coinfectados por el VIH 53 pacientes (9%) (porcentaje medio anual del 11,6% en 1995-1998; el 7% en 2003-2006). Se ha obtenido un cultivo de Löwenstein positivo en 431 pacientes (73,8%). La resistencia a isoniacida ha sido del 1,4% de entre 287 cepas analizadas y no se ha detectado multirresistencia. Nueve pacientes eran inmigrantes (1,5%). El cumplimiento del tratamiento en el Bajo Deba en el período 1995-2006 ha sido satisfactorio en 505 pacientes (86,4%), mientras en la provincia de Guipúzcoa lo era en 1.956 de 2.525 pacientes diagnosticados y tratados en el mismo lapso de tiempo (77,5%) (p < 0,01). Conclusiones. La comarca del Bajo Deba presenta una alta incidencia de tuberculosis en el período estudiado. La evolución epidemiológica ha sido positiva con disminución de la incidencia de tuberculosis, de la contagiosidad, de la coinfección por el virus de la inmunodeficiencia humana (VIH), y con desplazamiento de las mayores tasas de enfermedad desde los grupos jóvenes a la tercera edad. La resistencia a tuberculostáticos y la inmigración no han tenido un papel determinante en la epidemiología. El porcentaje de casos confirmados microbiológicamente ha sido alto y el cumplimiento del tratamiento, satisfactorio (AU)

Within the Multicenter Project on Tuberculosis Research performed in Spain in 1996-1997, the Bajo Deba Area reported the highest incidence of tuberculosis in the Basque Country. We analyzed the clinical and epidemiological characteristics of the tuberculosis population diagnosed in our area during the period of 1995 to 2006. Methods. Ambispective, observational study. Results. A total of 584 patients were diagnosed with tuberculosis. The disease affected the respiratory tract in 509 cases and other sites in 75 cases. The mean annual incidence rate of tuberculosis was 64.5 cases per 100 000 inhabitants (91.6 in 1995-1998; 34.9 in 2003-2006). The mean annual incidence rate of smear-positive patients was 20.7 cases per 100 000 inhabitants (33.8 in 1995-1998; 12.9 in 2003-2006). The 15 to 24-year-old group was the most highly affected during the period of 1995 to 1998 (mean annual incidence rate 199.4 cases per 100 000); in contrast, the > 75-year-old group was the most highly affected during the period of 2003 to 2006 (121.1 cases per 100 000 inhabitants). Fifty-three patients were co-infected by HIV (9%) (yearly mean of 11.6% in 1995-1998 and 7% in 2003-2006). Löwenstein culture was positive in 431 cases (73.8%). Resistance to isoniazid was detected in 1.4% out of a total of 287 strains tested, and multidrug resistance was not observed. Nine patients were immigrants (1.5%). Treatment completion was greater in our area (505 patients, 86.4%), as compared to that recorded in the Guipuzcoa province during the same period (1956 of 2525 patients, 77.5%) (P <.01). Conclusions. The Bajo Deba Area presented a high incidence of tuberculosis in the 1995 to 2006 period. Epidemiological trends showed a progressive decrease in the number of tuberculosis patients, with a shift from younger to older persons as the most highly affected age group. The impact of drug resistance and immigration was negligible on tuberculosis rates. The percentage of microbiologically confirmed cases was high. Treatment completion was satisfactory (AU)