Duration of treatment and other aspects of tuberculosis control

Item does not contain fulltext27 maart 2002Promotores : Verbeek, A.L.M., Meer, J.W.M. van der, Herwaarden, C.L.A. van Co-promotor : Veen, J.E. van de

Verkorting van therapieduur bij patiënten met longtuberculose van 9 naar 6 maanden verdedigbaar op grond van gepubliceerde gegevens

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Contact tracing using DNA fingerprinting in an asylum seeker with pulmonary tuberculosis.

Item does not contain fulltextBACKGROUND: The diagnosis of tuberculosis in asylum seekers is followed by contact tracing, which is routinely performed by the Municipal Health Service (MHS). We investigated cases of tuberculosis whose symptoms became apparent after closure of regular contact tracing. METHODS: Analysis of data from the DNA Fingerprinting Surveillance Project on all Mycobacterium tuberculosis isolates and contact tracing instances. RESULTS: Four additional cases of tuberculosis were detected, caused by bacteria of identical DNA fingerprints. No further contacts with a bacteriologically confirmed form of tuberculosis were found around these four new patients. CONCLUSION: DNA fingerprinting contributed to tracing instances of late manifestations of tuberculosis transmission

Pyrazinamide use as a method of estimating under-reporting of tuberculosis

Item does not contain fulltextOBJECTIVE: To develop a method of validating the notification of active tuberculosis by physicians in the Netherlands. METHOD: The chemotherapeutic agent pyrazinamide was used as a marker for the occurrence of tuberculosis. On the basis of defined daily doses (DDD) of pyrazinamide dispensed to out-patients, an estimate was made of the number of patients with tuberculosis in the Netherlands in the period 1994-1998. DDD is a technical unit of measurement and does not necessarily reflect the recommended or actual dose used. Usually it is based on the average dosage per day for the main indication in adults with normal organ function. The Dutch Drug Information Project (GIP) of the Health Care Insurance Board (CVZ) provided the DDD data. Based on the notification of tuberculosis patients to the Netherlands Tuberculosis Register (NTR) we calculated how much pyrazinamide (measured in DDDs) these patients would have used depending on their body weight. RESULTS: The number of DDDs prescribed according to the GIP pharmacy records differed by only 8% from the number of DDDs calculated on the basis of notification to the NTR; 6889 patients should have been registered instead of 6349. CONCLUSION: The close correlation between the use of pyrazinamide as measured by the GIP and NTR provides strong evidence that in the Netherlands tuberculosis is reported in conformity with the guidelines for notifiable diseases. The method was simple to apply and may deserve follow-up in other countries

Increase of bone and joint tuberculosis in The Netherlands

There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the diagnosis of BJTB may be shortened if physicians are more aware of tuberculosis

Tuberculous meningitis: is a 6-month treatment regimen sufficient?

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Tuberculous meningitis: is a 6-month treatment regimen sufficient?

Item does not contain fulltextSETTING: The British Thoracic Society and the American Thoracic Society advise 12 months treatment for tuberculous meningitis, with at least isoniazid (H), rifampicin (R) and pyrazinamide (Z). OBJECTIVE: To establish whether a 6-month treatment regimen for tuberculous meningitis is equally as effective as longer treatment. METHOD: Medline search for papers published between 1978 and 1999. Inclusion criteria: study populations of patients with tuberculous meningitis in whom the diagnosis was confirmed with clinical, cerebrospinal fluid and epidemiological findings; a treatment regimen with at least HRZ and at least 12 months of follow-up after the completion of treatment. Outcome measure: the number of relapses. RESULTS: There were four 6-month treatment regimens (G6) and seven longer treatment regimens (G>6); 160/197 (81%) patients completed the 6-month treatment regimens, while 577/675 (85%) completed the longer-term regimens. The clinical stage of patients in the G6 group was poorer than in the G>6 group. Relapse occurred in two out of 131 (1.5%) G6 and in 0 out of 591 G>6 patients. CONCLUSION: Although no studies have compared 6-month treatment regimens with longer treatment, it can be concluded on the basis of this literature review that 6-month treatment is sufficient for tuberculous meningitis with fully susceptible mycobacteria