Rifampicin plus isoniazid for the prevention of tuberculosis in an immigrant population.

OBJECTIVES: To compare the tolerance, adherence and effectiveness of two approaches for the treatment of latent tuberculosis infection (LTBI): 6 months of isoniazid (6H) vs. 3 months of isoniazid plus rifampicin (3RH). POPULATION: Immigrants with LTBI. METHODS: Participants were enrolled in a controlled, randomised clinical trial in Barcelona, Spain, from April 2001 to April 2005. Monthly follow-up was done to assess tolerance, side effects and adherence. Effectiveness was evaluated at 5 years. RESULTS: In the 590 subjects enrolled, the rate of adherence was greater in the 3RH than in the 6H arm (72% vs. 52.4%, P = 0.001). No differences between study arms were observed with respect to hepatotoxicity or side effects. Variables associated with non-adherence were diagnosis by screening (OR 1.88, 95%CI 1.26-2.82, P = 0.001), illegal immigration status (OR 1.48, 95%CI 1.01-2.15, P = 0.03), unemployment (OR 1.91, 95%CI 1.28-2.85, P = 0.0008), illiteracy (OR 1.73, 95%CI 1.04-2.88, P = 0.02), lack of family support (OR 3.7, 95%CI 2.54-5.4, P = 0.001) and the 6-month treatment regimen (OR 2.45, 95%CI 1.68-3.57, P = 0.0001). None of the patients who completed either treatment developed tuberculosis. CONCLUSIONS: The 3RH regimen facilitates adherence to LTBI treatment and offers a safe, well-tolerated and effective alternative.

[Active tuberculosis case finding among immigrants in Barcelona]. / Búsqueda activa de tuberculosis en inmigrantes en Barcelona.

OBJECTIVE: To assess the prevalence of tuberculous infection and disease in recent economic immigrants in Barcelona. SUBJECTS AND METHOD: Examination and testing of immigrants. Tuberculin tests (TTs) were given and the presence of scars from tuberculosis vaccinations were noted. Thresholds of 5 and 15 mm were established for positivity in unvaccinated and vaccinated individuals, respectively. RESULTS: A total of 3651 persons were examined, but only 3151 completed the study. Eighteen were diagnosed with tuberculosis (571.2 per 100,000) and 50.6% were classified as positive TT reactors, 34.4% because of infection and 16.3% possibly because of tuberculosis vaccination. The percentage of reactors was significantly higher in the sample of economic immigrants than in the local population. Age, male sex, place of origin, greater poverty, and higher prevalence of disease in the country of origin were associated with tuberculous infection in the sample. DISCUSSION: Active case finding proved efficient. Interference from tuberculosis vaccination greatly affects the findings, depending on the positivity threshold that is established. We recommend that chest radiographs be used in addition to TTs. Immigration will change the nature of endemic tuberculosis in Spain, and strategies should be specifically designed to deal with the new challenges that will appear.

Estudio de la infección tuberculosa en adultos / A study of the tuberculous infection in adults

La infección tuberculosa en adultos no es muy conocida en nuestro país a pesar del interés epidemiológico que tiene. Se diseñó un estudio observacional en un grupo homogéneo de adultos funcionarios de Cataluña (n = 8.202) de 20 a 54 años de edad que se sometieron a un examen de salud, en el que se incluyó una prueba de tuberculina, con objeto de estudiar la infección tuberculosa en ellos y evaluar los factores relacionados con la misma. Resultados. La prevalencia global a la reactividad de la prueba de la tuberculina es del 22,36 por ciento y la prevalencia de la infección tuberculosa del 14,76 por ciento. Los factores relacionados con la infección tuberculosa son: edad, sexo masculino, antecedentes de exposición a fuentes de contagio y vacunación antituberculosa (BCG) previa. Conclusiones. La prevalencia de la infección tuberculosa en adultos ha descendido, siendo mayor en hombres que en mujeres, entre los que reconocen haber tenido contacto con un enfermo tuberculoso y entre los que fueron vacunados con BCG (AU)

[A study of the tuberculous infection in adults]. / Estudio de la infección tuberculosa en adultos.

UNLABELLED: Tuberculous infection in adults is not a well known entity in our country, despite its epidemiological importance. We have designed an observational study in a homogeneous group of adult civil servants of Catalonia (n = 8,202) from 20 to 54 years old that were submitted to a health examination which included a tuberculin test, in order to study the tuberculous infection in these people and to evaluate the factors associated with this infection. RESULTS: The global prevalence of reactivity in tuberculin test was 22.36% and the prevalence of the tuberculous infection was 14.76%. The factors related to the tuberculous infection were the following: age, male sex, background of exposure to sources of contagion, and previous BCG vaccination. CONCLUSIONS: The prevalence of tuberculous infection in adults has declined, and is currently greater in men than women, among patients who recognize previous contact with a tuberculous patient, and among patients with previous BCG vaccination.

[Pulmonary symptomatic tuberculosis' diagnostic delay study]. / Estudio del retraso diagnóstico de la tuberculosis pulmonar sintomática.

OBJECTIVE: To study symptomatic pulmonary tuberculosis (PTB) diagnostic delay. PATIENTS AND METHODS: Prospective study of new symptomatic PTB cases (aged > or = 15 years) by structured interview with the patients and their families. The main variables analyzed were patient's delay (PD), doctor's delay (DD), diagnostic process delay (DPD), health care system delay (HCSD) and total delay between the onset of symptoms and start of treatment (TD). Univariate and multivariate statistical analyses were performed for each component of delay. RESULTS: Two hundred eighty-seven patients were studied. The mean delays in days standard deviations were TD 81.8 77.3; PD 43.3 55.7; DD 28.4 59.6; DPD 10.0 17.7, and HCSD 38.5 62.5. CONCLUSIONS: Patients are responsible for 50% of excess delay in diagnosing symptomatic PTB. Patients in the health care system experienced diagnostic delays over 60 days in 18.5% of cases, doctors being responsible for 75% of the diagnostic delay attributable to the system.

Estudio del retraso diagnóstico de la tuberculosis pulmonar sintomática / Pulmonary symptomatic tuberculosis' diagnostic delay study

OBJETIVO: Estudiar el retraso diagnóstico de la tuberculosis pulmonar (TBP) sintomática. PACIENTES Y MÉTODOS: Estudio prospectivo de casos nuevos sintomáticos de TBP (edad 15 años) mediante entrevista estructurada al paciente y su familia. Las variables fundamentales analizadas fueron: retraso del enfermo (RE), retraso atribuible al médico (RM), retraso durante el proceso diagnóstico (RPD), retraso en el sistema sanitario (RSS) y retraso total (RT), esto es, el tiempo transcurrido desde el comienzo de los síntomas hasta el inicio del tratamiento de la TBP. Se realizó un análisis estadístico univariante, así como análisis multivariante para cada uno de los componentes del retraso diagnóstico. RESULTADOS: Se estudió a 287 enfermos. La media en días ñ desviación estándar (DE) fue para el RT y sus distintos componentes de 81,8 ñ 77,3 en el RT, 43,3 ñ 55,7 días en el RE, de 28,4 ñ 59,6 días en el RM; para el RD, de 10,0 ñ 17,7 días y en el RSS de 38,5 ñ 62,5 días. CONCLUSIONES: Dentro del elevado retraso diagnóstico de la TBP los enfermos son responsables del 50 por ciento. En el sistema sanitario el 18,5 por ciento de los enfermos sufrió un retraso diagnóstico mayor de 60 días, siendo los médicos responsables del 75 por ciento de la demora atribuible al sistema (AU)