Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018. Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018. Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).   Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation.     Conflicts of interest: None declared

Value of bronchoscopy in the diagnosis of sputum smear negative pulmonary tuberculosis

Background: Bronchoscopy has been found to be applicable in diagnosing suspects of pulmonary TB which have no sputum or sputum smear negative for acid fast bacilli. Additionally, it is helpful in the diagnosis of endobronchial tuberculosis, allowing early detection of broncho stenosis.Methods: A prospective study, where bronchoscopy was conducted in 167 patients with acid-fast bacillus sputum smear negative. The average age of the patients was 44.1±19.4, from age 15 to 87 years old, higher frequency in age from 20-40 years old and 55-64 years old.Results: From 167 patients in the study, endoscopic presentation resulted: normal in 7 (4.2%) cases, bronchitis - 60 (35.9%) cases, oedematous-hyperaemic -62 (37.1%) cases, caseous inflammation - 7 (4.2%) cases, ulcerative lesions - 3 (1.8%) cases, tumoral lesions - 21 (12.6%) cases and fibrous stenotic changes in 7 (4.2%) patients. From 44 (26.3%) patients to whom was obtained biopsy, the histological examination has resulted: 24 (54.5%) cases with TB granuloma, 14 (31.8%) - epithelioid granulomas and in 6 (13.6%) cases resulted non-specific inflammation. The examination of bronchial washing for acid-fast bacillus smear concluded the diagnosis in 40.4% of cases, the examination for acid-fast bacillus smear collected after diagnostic FBS has been decisive in 53.9% of cases. The examination for acid-fast bacillus culture resulted positive in 70.5% of bronchial washing and in 61.2% of sputum collected after FBS.Conclusions: Fibreoptic bronchoscopy plays the key role to the patients with suspected tuberculosis which are acid-fast bacillus smear negative or that have no sputum

Pancoast tumor approach through oesophagus

Patient with Pancoast Tumor usually present in advanced stage of the disease which requires chemotherapy and radiotherapy as options of treatment. Histologic confirmation is a key for further treatment of these patients. Normally in bronchoscopy the lesion can't be visualised and in result making biopsy difficult to perform. Transthoracic biopsy through computed tomography poses anatomic difficulties and not always the pulmonary lesion can be reached. We report a case of pancoast tumor in a 68 year old male who presented with left arm pain and upper lobe increased density mass in chest x ray. Computed tomography confirmed an upper lobe mass of the left lung with invasion of the chest wall. It was successfully diagnosed with biopsy taken through the oesophagus of intrapulmonary mass with the EBUS bronchoscope (EUS- B FNA). No complication were observed during and after the procedure. To our knowledge this is the first case of making the diagnosis of lung carcinoma Pancoast tumor using EBUS bronchoscope with approach through oesophagus (EUS-B FNA). There may be a role in using EBUS specifically to diagnose a pancoast tumor in the right patient population