[The results of the chemotherapy of a patient cohort with pulmonary tuberculosis followed-up for a 3-year period]. / Rezultatele obtinute prin chimioterapie la o cohorta de bolnavi cu tuberculoza pulmonara, urmariti timp de 3 ani.

In 1992, in the fourth district of Bucharest 184 news adult patients with pulmonary tuberculosis were registered, and they received specific chemotherapy. The initial sputum bacteriological examination was M+C+ in 63.1% of these patients, M-C+ in 21.7% and M-C- in 15.2%. After three years of surveillance the results of the treatment were evaluated. 27 patients were excluded from the initial group, because they failed to be controlled. The final results were influenced by the sex and the initial bacteriological examination of sputum: the persistent negativation of sputum was obtained in 96.2% of the women, and only in 89.5% of men; depending on the initial bacteriological sputum examination, 100% of the M-C+ cases were negated, but only 86.4% of the M+C+ group.

[Tuberculosis in the elderly: sociomedical aspects]. / Tuberculoza la varstnici; aspecte medico-sociale.

A study on a group of 100 tb patients aged over 60 years registered between 1987-1991 in the district 4 of Bucharest has been carried out aiming at the evaluation of medical and social aspects. In order to increase the relevance of the obtained data, these were compared with a group of young tb patients aged 20-39 years, in the same territory and period of time. The results show: the case-finding predominantly passive, extrarespiratory forms in 25%, high contamination risk (63% acid fast bacilli eliminators on microscopy) non-compliance to treatment in 1/5 of cases. These aspects could be explained by psychic particular features in aged persons, associated diseases a.s.o., leading to treatment failures. The analysis of social and epidemiological aspects of tb in aged subjects evidences some lack of good results in this important public health problem of people.

[The exclusively outpatient treatment of pulmonary tuberculosis under the conditions in Romania]. / Tratamentul exclusiv ambulator al tuberculozei pulmonare în conditiile tarii noastre.

In order to demonstrate the possibility of an exclusively outpatient treatment of pulmonary tuberculosis in the present conditions in our country, a study was performed on 140 cases in Bucharest. The admission criteria were as follows: sputum negative patients (M-C-); paubacillary cases, sputum positive only in culture (M-C+); Tb pleuritis; patients refusing hospitalization, regardless their bacteriological status, and sputum positive cases also at smear examination (M+C+), if they had no household contacts under 20 years of age or with a good social economic standard of life. The patients were given the intensive chemotherapy regimen HSRZ 2/7 for 6 months, that was prolonged to 9 months in specified cases. A number of 31 patients were non-bacillary (M-C-) out of which 14 cases with pleuritis; 70 were paucibacillary (M-C+), and 39 were smear positive (M+C+). Out of 109 patients which were bacteriologically confirmed, sputum reversion in culture was obtained in 71.6% of cases at 2 months and in 89.0% at 3 months. At treatment end, sputum negativation was not obtained in a single patient (0.9%). Case follow-up for 6-41 months after treatment end led to the registration of 8 therapeutical failures and bacteriological relapses (5.7%). Five cases recovered through re-treatment, 1 patient (0.7%) died through tuberculosis, and 2 (1.4%) became chronic case. Periodical control of the 95 contact children in the respective households revealed a single conversion of the tuberculin reaction and no Tb case after treatment start in index cases, which proves the epidemiological reliability of the method.

[The evolution and structure of morbidity from extrarespiratory tuberculosis in the last 15 years in Romania]. / Consideratii privind evolutia si structura morbiditatii prin tuberculoza extrarespiratorie în ultimii 15 ani in România.

Though in comparison with the overall lethality of tuberculosis the extra-respiratory localizations of the disease showed a markedly less weight than the respiratory ones during the past 15 years (12.8% in 1975 and 6.7% in 1989), this pathology chapter is still essential due to the diversity of Tb forms and localizations. The annual average rate of the decrease in extra-respiratory tuberculosis incidence was of 4.8% between 1975-1989, so the incidence value reached 4.2%000 at the end of the last year of study. Just like 15 years ago, in 1989 the extra-respiratory tuberculosis incidence was dominated by the localizations on the peripheral lymph nodes (1.2%000), on bones and joints (1.0%000), urogenital apparatus (0.7%000), meninges and central nervous system (0.5%000). The prevalence of patients with extra-respiratory Tb localizations was gradually diminished so that only 3415 cases were registered in the IIIrd group of the active case-index in 1989 (13,524 in 1975). More than half of the number of deaths through extra-respiratory tuberculosis were still due to tuberculous meningitis, particularly in children aged 0-4 years (82% of deaths in 1989). A further diminution up to a total elimination of extra-respiratory Tb localizations (still about 1,000 new cases a year) can be reached only by a restriction and liquidation at the same time of both primary and secondary pulmonary tuberculoses.

[The risk of tuberculosis infection and disease among children in contact with tuberculous foci]. / Riscul de infectie si îmbolnavire prin tuberculoza al copiilor contacti în focarele tuberculoase.

Three groups of children aged 0-14 years, in the 4-th district of Bucharest, have been followed up during 1988-89, as follows: a retrospective group--331 contact children in new tb foci registered in 1986-87; a prospective group--213 contact children in newly registered foci in 1988 and a group of 49 contact children in chronic foci. The children have been controlled clinically and X-ray and tuberculin tested on case-finding of the index-case and 3, 6 and 12 months thereafter; those from the retrospective group even after 2-3 years. The non-infected children were BCG vaccinated; in those infected chemoprophylaxis was administrated. The most dangerous infection sources for children were the tb bacilli eliminators on microscopy. The tuberculin conversions were noted during the first 3-6 months after contact; the children from chronic foci can converse even after 1-3 years. The active tuberculosis in children were noted on the initial check-up and were missing during the follow-up period, even in chronic foci. These observations could be accounted to the prophylactic measures applied in contact children, corroborated with intensive treatment of infection sources. Since most of disease cases in children were under 2-3 years of age, we consider necessary to continue the BCG vaccination at birth.