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CLINICAL FOLLOW-UP OF LABORATORY DIAGNOSED MDR-TUBERCULOSIS CASES AND EXAMINATION OF THEIR CLOSE CONTACTS.

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  1. CLINICAL FOLLOW-UP OF LABORATORY DIAGNOSED MDR-TUBERCULOSIS CASES AND EXAMINATION OF THEIR CLOSE CONTACTS Z.Kılıçaslan(1), N.Sarımurat(2), F.Öztürk(2), İ.Coşkunol(2), B.Kısa(2), G.Asoğlu(2), V.Oktay(2), H.Akyüz(2), R.Doğal(2), S.Gür(2), Ş.Kümbetli(2), C.Küçük(2), S.Karslıoğlu(2), E.Seber(3), G.Öngen(4) Istanbul University, Istanbul Medical Faculty, Department of Chest Diseases Istanbul Anti-Tuberculosis Dispensaries Istanbul Anti-Tuberculosis Association, Main Bacteriology Laboratory Istanbul University, Cerrahpaşa Medical Faculty, Department of Chest Diseases

  2. AIM Determination of the clinical follow-up of Laboratory diagnosed MDR Tuberculosis patients. Determination of the disease risk for close contacts of clinically diagnosed MDR Tuberculosis patients.

  3. MATERIAL and METHOD This study is based on retrospective data sheets from 13 TB control dispensaries in İstanbul and the main TB laboratory in İstanbul. Between the years 1997-2005, 341 registered TB patients at the above mentioned dispensaries were laboratory-diagnosed MDR-TB.

  4. MATERIAL and METHOD Most of the MDR-TB cases were decided clinically by the cooperation with the Lung Diseases Hospitals in İstanbul(Yedikule, Süreyyapaşa) The close contacts of the MDR-TB patients who were clinically diagnosed, were evaluated by them being called to the dispensaries or them being telephoned.

  5. FINDINGS No. of lab. MDR-TB cases: 341 (F:80 M:261) Clinically not followed-up: 56 Clinically followed-up: 285 (F:67 M:218)

  6. FINDINGS 285 followed-up lab. MDR-TB cases • Clinically not diagnosed MDR-TB :118(41.4%) • Clinically Diagnosed MDR-TB : 167(58.6%) • MDR-TB Treatment started with minor drugs: 151

  7. Present status of clinical MDR-TB patients (n:118)

  8. FINDINGS 167 cases accepted as clinically MDR-TB SEX: Female: 36 (21.5%) Male: 131 (78.5%) AVERAGE AGE: 35.3 (15-69)

  9. FINDINGS EDUCATIONAL STATUS: Primary School: 95 (56.9%) High School: 26 (15.6%) Elementary School: 24 (14.4%) Uneducated: 18 (10.8%) University: 4 (2.3%) MARITAL STATUS: Married: 93 (55.7%) Single: 74 (44.3%)

  10. FINDINGS WORK STATUS: Worker: 66 (39.5%) Unemployed: 38 (22.7%) House Wife: 26 (15.6%) Self Employed: 21 (12.6%) Government Employee: 9 (5.4%) Other: 7 (4.2%)

  11. FINDINGS HEALTH INSURENCE: Non-Insured: 67 (40.1%) Insured: Yeşilkart: 46 (27.5%) SSK: 28 (16.8%) Bağkur: 11 (6.6%) E.Sandığı: 8 (4.8%) Unknown: 7 (4.2%)

  12. FINDINGS CONTACT: In Contact: 56 (33.5%) No Contact: 105 (62.9%) Unknown: 6 (3.6%) MDR-TB CONTACT: In Contact: 28 (16.8%) No Contact: 127 (76%) Unknown: 12 (7.2%)

  13. FINDINGS Clinically diagnosed 167 MDR-TB cases: Primary: 94(56.3%) Secondary: 68(40.7%) Unknown: 5(3%) Treatment started with minor drugs:151

  14. Present status of clinical MDR-TB patients (n:167)

  15. EVALUATION of CLOSE CONTACTS The 167 MDR-TB cases had a total of 542 close contacts(average: 3.2) Among them 296 were female, and 246 were male. The follow-up time for close contacts was 72.9 months in average(min. 1, max. 193 months), after the index case was first found.

  16. AGE of CLOSE CONTACTS % n:542 35.1 29.2 29,4

  17. CLOSE CONTACTS During the follow-up of 542 close contacts; MDR-TB: 21(3.9%) TB: 52(9.6%) TOTAL: 73(13.5%) new cases were diagnosed. Risk of MDR-TB: Among Male Contacts: (13/246) 5.3% Among Female Contacts (8/296) 2.7%

  18. THE AGES of TB and MDR-TB DIAGNOSED CLOSE CONTACTS % 47.7 42.3

  19. DISCUSSIONRestrictions in this Study • This study was a retrospective one. • The treatment regime with major drugs were not questioned, therefore in a presence of treatment failure, the case was accepted as MDR-TB. • The treatments were not under DOT.

  20. DISCUSSION In a study involving six countries, it was found that the result of the treatments of MDR-TB patients who were given the standard treatment regime with DOT was 21% failure and 9% death. This ratio is 34% and 11% in previously treated MDR-TB cases(1) One study in India showed a 66.7% failure rate in secondary MDR-TB patients given the standard treatment regime(2) 1.Marcos A. Espinal ve ark. JAMA, May 17, 2000—Vol 283, No. 19 2.Sophia Vijay.ve ark Ind. J. Tub. 2002, 49, 195

  21. DISCUSSION One study in Russia found that 18 MDR-TB cases having been cured with standard short-course therapy, had a 27.8% relapse rate after an average of 6.5 months of follow-up. G. B. Migliori et all.Frequency of recurrence among MDR-TB cases ‘successfully’ treated with standardised short-course hemotherapy INT J TUBERC LUNG DIS 6(10):858–864 2002 IUATLD

  22. DISCUSSION In a study at Süreyyapaşa Chest Diseases Hospital; Among the 39 lab. MDR-TB patients, who were given the standard short-course therapy, there was a failure rate of 20.5%(8 cases) Whereas, MDR-TB patients who previously were treated had a failure rate of 40%(8/20). Çalışır H.C et all Toraks Dergisi. Cilt 7 Ek 1. 2006

  23. RESULT This study, with its restrictions, is showing that nearly 60% of the lab. MDR-TB cases were accepted as clinical MDR-TB cases in the dispensaries in İstanbul. Close contacts of MDR-TB patients have a high rate of MDR-TB occurance.

  24. THANK YOU

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