Drug-resistance of Mycobacterium tuberculosis in time.

Tuberculosis is heavily worldwide spreading in the last years. More and more signalations seem to indicate that the incidence of drug-resistant Mycobacteria is increasing in almost all industrialized countries. The authors have carried on a study on the percentage of drug-resistant strains of Mycobacterium Tuberculosis (MT) among isolates from patients affected by active pulmonary tuberculosis hospitalized through the years 1992-94. Out of 59 isolates of MT, 20.3% were drug-resistant: 25% of them to 2 drugs and 16.6% to 3 or more drugs. Resistance to single drug was so distributed: Streptomycin 11.8%, Isoniazid 6.7%, Rifampycin 3.4%, Ethambutol 6.7%, Ansamycin 3.4%, Pyrazinamide 5.0%, Ethionamide 1.7%. These results were confronted with analogous data on MT drug-resistance collected in the same hospital division in the years 1978-82 and 1985-87. The data analysis shows that actual incidence of drug resistant strains of MT is only slightly decreased but quite similar to that observed in 1978-82, except for Ethambutol, while there is a remarkable reduction vs. 1985-87; in that period, in fact, the highest incidence of drug resistance was recorded. The authors' conclusion is that only little differences were observed in the total amount of resistant strains of MT through 20 years; they also outline that resistance to Ansamycin, most recent out of all tested drugs, is quite similar to that observed for Rifampycin, that is chemically analogous.

Post-tuberculosis chronic empyema of the "forty years after".

The authors present 110 cases of patients hospitalized in the last 5 years, with long-term disabling sequelae of pulmonary tuberculosis. Twelve out of them (= 10.9%) suffered from post-tuberculous chronic empyema, with an average latency period of 44.83 years between the acute tuberculous illness and the clinical manifestation of the empyema. Nine of the patients had been treated with collapsotherapy, induced by artificial intrapleural pneumothorax, 1 with thoracoplasty, and 2 only with late and inadequate anti-mycobacterial chemotherapy. Eleven patients (91.6%) also had a cutaneous fistula (7 cases) and/or a bronchopleural fistula (4 cases). The authors show how the issue of tuberculous sequelae is a significant not only from the numerical standpoint, but also for the seriousness of the caused pathological conditions, often posing problems for differential diagnosis. Moreover, they stress how tuberculosis should never be neglected or considered last in the differential diagnosis of empyema and pyopneumothorax.