Poster Discussion

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M ONDAY, S EPTEMBER 4 TH 2006
related to multidrug-resistant tuberculosis (MDR-TB), the resistance patterns to
anti-TB drugs and analyse the treatment outcomes.
Methods: Eighty-three patients admitted in a tuberculosis unit, from May 1999
to April 2004 with the diagnosis of MDR-TB (with bacillary resistance to at least
isoniazid and rifampin) were retrospectively analysed.
Results: The patients (median age, 40 years) were mainly males (80%), unemployed (52%) and had pulmonary involvement (93%). Forty five percent were
human immunodeficiency virus (HIV)-coinfected and 46% were drug addicts.
Primary MDR-TB was found in 25 (30%) patients and the others had acquired
MDR-TB: 18% relapses and 52% retreatments (30% defaulted). Isolated Mycobacterium tuberculosis strains were resistant to an average of seven anti-TB drugs
(range 2 to 11). Thirty-one (37%) of MDR strains were simultaneously resistant
to the five first-line anti-TB drugs and to at least two second-line. In follow-up we
have the outcomes of 70 cases: 47 (67%) died, 9 (13%) had a favourable outcome,
8 (11%) still were in treatment and 6 (9%) were lost before treatment completion.
Conclusions: This study shows a strong prevalence of M. Tuberculosis with resistance pattern similar to W strains (resistant to the five first-line anti-TB drugs
and to at least two second-lines); HIV/AIDS coinfection was frequent and drug
addiction was the most important risk factor. This could explain the high frequency
of no adherent patients drug regimens. Mortality was very high in this group of
patients. Local TB control efforts are needed to prevent the further development
and spread of MDR-TB.

P2245
A joint TB re-treatment project for the poor
Halim Danusantoso 1 , Yulismar 2 , Gwan Tjaij The 3 . 1 Medical Faculty, Trisakti
University, Jakarta, Indonesia; 2 TB Control Clinic, Indonesian TB Control
Association, Jakarta, Indonesia; 3 Association of Airlangga University Alumni in
the Netherlands, Association of Airlangga University Alumni, Almere, The
Netherlands
The 28 years old Tuberculosis (TB) Control Clinic for the Poor of the Indonesian
TB Control Association-Jakarta branch is known as the last resort for Poor TB
patients, new and retreatment, to get free complete treatment.
In 2004 the Association of Airlangga University Alumni in the Netherlands, together with the Dutch Stichting Supplitiefonds Sonnevanck, have adopted 60
retreatment cases in this Clinic, providing the tuberculostatics to be used.
Patients must have symptoms and signs of TB (clinical/radiological), be Sputum
Smear+ (Sm+) and have received 3 months specific treatment in the past. A
Lowentein-Jensen culture with Resistency test is also done.
There are 35 males (20-72 years) and 25 females (15-72 years) with 12 Multi
Drug Resistant (MDR) and 48 Non-MDR cases.
All patients have formerly been treated blindly (without pretreatment Resistency
test) with the standard DOTS regimen (2HRZE/4H3 R3 ), either in this Clinic or
elsewhere.
As in the first 2 months Resistency results are still unknown, patients are treated
with the same DOTS regimen, but now fortified with Ciprofloxacin 1g and Streptomycin 1 g in the Daily phase and Ethambutol in the Intermittent, now extended
till 9 months. 1 Non-MDR patient moves to another place, leaving 59 patients
eligible for evaluation (100%).
After completing the 9 months treatment course, 52 patients convert to Sm- (88.1%),
5 patients become again Sm+ (8.5%) and 2 patients die during treatment.(3.4%).
There are no defaulters thanks to the Contract system, in use since 1978.
A closer look at the 5 treatment failures reveals that 1 is HIV+, 2 have MDR TB.
With this regimen the resting 10 MDR cases can still be bacteriologically cured
(83.3%). Probably this is due to a.m. fortifications.

P2246
Knowledge and management of tuberculosis among general practitioners in a
high burden developing country
Irfan Muhammad, Javaid A. Khan, Shehzadi Romana, Zohra Tatheer. Pulmonary
Section, Aga Khan University Hospital, Karachi, Pakistan

203. Epidemiology of susceptible, resistant

and multidrug-resistant tuberculosis
(MDR-TB)
P2244
Multidrug-resistant tuberculosis in a tuberculosis unit results of five years
Paulo Mota, Nelson Diogo, Jaime Pina. Pneumology, Hospital Pulido Valente,
Lisbon, Portugal
Objectives: Describe clinical characteristics, identify the most frequent factors

Objective: To assess the knowledge of General Practitioners (GPs) regarding

diagnosis and management of tuberculosis.
Methods: The study was a cross-sectional survey. The tool for data collection was
a questionnaire with open and close ended questions. General practitioners from
N.W.F.P and the Northern areas of Pakistan were evaluated. Verbal consent was
taken before giving them the questionnaires. The sampling strategy was convenient
sampling.
Results: Out of 88 GPs 43% regarded sputum microscopy and 22% chest radiograph as the best test to confirm the diagnosis of pulmonary TB. During the
follow up of pulmonary TB patients 32% doctors considered chest radiograph
as the best investigation while sputum microscopy was chosen by only 28%.
Eighty seven percent of GPs correctly identified TB as a droplet infection but 6%
considered sexual contact to be the main mode of spread of this disease. Two third
of the prescriptions, written for a 60 kg man with newly diagnosed smear-positive
pulmonary TB, were not in line with national guidelines. Only 3% of the GPs
knew all the five components of DOTS.
Conclusion: Sever deficiencies were seen in the management of TB by GPs of
Northern areas of Pakistan. National TB control Program must take appropriate
measures to educate and train the GPs in TB management. Without involving the
GPs, Pakistan will not succeed in TB control.

377s
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Poster Discussion

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M ONDAY, S EPTEMBER 4 TH 2006

P2247
Analysis of treatment failure in cohort I of the Tomsk DOTS-plus program
(2000 2002)
Tamara P. Tonkel 1 , Gennady G. Peremitin 1 , Olga B. Sirotkina 1 , Aivar
K. Strelis 2 , Alexander D. Pasechnikov 3 , Askar B. Yedilbayev 3 , Alexander
A. Golubkov 3 , Yevgeny G. Andreev 4 . 1 Tomsk Oblast TB Dispensary, Tomsk
Oblast TB Dispensary, Tomsk, Russia; 2 Department of Tuberculosis, Siberian
State Medical University, Tomsk, Russia; 3 Representative Office, Partners In
Health, Boston, MA, United States; 4 Medical Department, Federal Service of
Corrections, Tomsk, Russia

Current status of patients in relation to the resistance

Introduction: 244 MDR-TB patients from civilian (131) and prison (110) sectors received DOTS-Plus treatment between 09/2000-09/2002 (M=19.2 months).
79.5% culture positive at start of treatment, the rest were smear/culture positive
4.8 months prior to DOTS-Plus.
Object: To show that treatment failure is associated with late start of DOTS-Plus.
Methods: MDR-TB was documented in all patients before DOTS-Plus. Clinical,
laboratory, radiographic, bacteriological monitoring including DST, management
of adverse reactions to second line drugs and treatment of co-morbid conditions
were performed during all course of chemotherapy. Incentives and enablers were
provided to improve adherence to all patients. Outcomes: 78.3% cured, 9.8%
defaulted, 6.6% failed, 4.9% died, 0.4% transferred out.
Results: All failures (13 males, 3 females) had an extensive bilateral disease,
history of 2-4 inadequate treatments in past. Nine patients received Ofl, Eth, Km
before. Resistance prior to DOTS+: HRSEKZ - 4, HRSEZ - 4, HRSEK - 4, HRS
- 3. One was resistant to Ofl, 3 to Cap, 3 to Eth. Quality control was performed at
MSLI. 87.6% of failures had chronic alcohol abuse, 87.5% were unemployed.
Conclusion: Out of 244 patients 16 remained smear/culture positive during DOTSPlus with amplification to second line drugs in 93.7% and further TB progression.
An adequate and aggressive treatment should be started once MDR-TB is confirmed
by DST.

medicaments sensible to the initial regimen, regimen error, lack of compliance

have influenced to worsen the prognosis, high probability to become chronic, and
death risk. Significant negative impact was seen due to expression of resistance,
MDR, resistance to RFM, and secondary resistance.

P2248
Late consequences of bronchial tuberculosis a review of 81 cases
Mihai Alexe, Ruxandra Ulmeanu, Emilia Crisan, Petronela Grigore,
Iulia Andreescu. Bronchology, Institute of Pneumology Marius Nasta,
Bucharest, Romania
The bronchial tuberculosis is getting over, frequently, with mutilative scars, having
as a consequence a large respiratory pathology.
The study involved bronchoscopies performed in our Institute in 2002 (7641 bronchoscopies). In 81 cases we have detected mutilative bronchial sequels at patients
with history of tuberculosis. The age was between 31 and 87 years.
The bronchoscopy has been indicated for:
haemoptysis
(hydro, pio) pneumothorax
bronchiectasis
fibrosis
tuberculosis
pneumonia?
cancer?
solitary nodules
The momentum of active tuberculosis was between one and 67 years.
We have detected different aspects:
infundibular antracotic and/or concentric scars
bronchial tranctions and dilatations
scars suggesting former fistula
extrinsic compressions (old adenopathies)
hypotonic dyskinesia
It was detected 5 punctiform stenosis of the main bronchus (3 right, 2 left).
In 4 cases the trachea was seriously affected: stenosis 50%.
At 15 patients it has been detected reactivation of bronchial tuberculosis.
The mutilative sequels coexisted with tracheomalacia at 3 cases.
At one patient, it has been associated condroosteoplastic tracheopathy.
Conclusions: The consequences of the vicious recovery in bronchial tuberculosis could be serious and it must be correctly evaluated. Fibrobronchoscopy remains
the major method to be selected.

P2249
Long-term results of drug resistant tuberculosis treatment
Jeta Beli, Jul Bushati. Lung Disease, University Hospital of Lung Disease,
Tirana, Albania
Aim: Evaluation of long-term results of drug resistant tuberculosis treatment;
impact of resistance, patients, doctors and diseases factors.
Material and Method: In the year 2005 there are evaluated 118 patients with
any drug resistance recovered during 1986-2002 years: 61(51.7%) with primary
and 57(48.3%) with secondary resistance; 83(70.3%) to STM, 48(40.7%) to INH,
22(18.6%) to RFM, 6(5.1%) to EMB; and 18(15.3%) MDR-TB.
Results: Better results were seen at new cases compared with chronic and
reactivation cases. According to the diagnosis worse results were seen in the
patients with fibro cavernous Tb, Silico-Tb, Cavernous Tb, and empyema Tb.
Conclusions: Such factors like age, male, gravidity of disease, fewer number of

Resistance

Stable(%)

Chronic (%)

Dead (%)

Total (%)

STM
INH
RFM
EMB
MDR
Primary
Secondary

63 (75.9)
29 (60.4)
8 (36.4)
2 (33.3)
6 (33.3)
56 (91.8)
29 (50.9)

2 (2.4)
7 (14.6)
5 (22.7)
1 (16.7)
5 (27.8)

18 (21.7)
12 (25)
9 (40.9)
3 (50)
7 (38.9)
5 (8.2)
19 (33.3)

83 (100)
48 (100)
8 (100)
6 (100)
18 (100)
61 (100)
57 (100)

9 (15.8)

P2250
The diagnostic meaning of clinical-epidemiological signs among MDR TB
patients
Marina D. Safaryan 1 , David G. Khachatryan 2 . 1 Phthisiopulmonology, Yerevan
State Medical University, Yerevan, Armenia
1114 TB patients have been investigated to reveal the diagnostic meaning (DM) of
clinical and epidemiological signs using serial heterogeneous procedure of diagnose by A. Wald. Patients divided into two groups: A1 - MDR patients (23,5%) and
A2 including drug susceptible and other than MDR drug resistant cases (76,5%).
Patients cohort included males - 85%, females - 15%, 0-14y. 1,44%, 15-24y.
38,78%, 25-34y. 17,06%, 35-44y. 18,04%, 45-54y. 16,79%, 55-64y. 4,76%
and 65 and higher 3,14%. Microscopy result was positive in 70,74% of all cases.
The targets signs included gender, geographical localization, microscopy results,
TB localization and treatment duration divided into discrete scales. The results
of investigation has shown that MDR highly correlate with previous treatment
history (DM=3,07), smear positive cases (DM=1,64), among middle age groups
(DM=2,23) and among Armenian immigrants from Commonwealth of Independent
States especially from Russia (DK =5,08). The same time low (negative) correlation with MDR TB revealed in children (DM= -6,64), patients from high level
mountain regions (DM= -4,41) and smear negative patients (DM= -2,20).Other
signs will be examined during further investigations.

P2251
Multi-drug resistant tuberculosis (MDR-TB) in Ramnicul Valcear, Romania;
drug treatment, resistance testing and adverse drug reactions
Sorana White, Jonathan S. Mann. Respiratory Medicine, New Cross Hospital,
Wolverhampton, West Midlands, United Kingdom
Introduction:MDR-TB is an increasing problem in Eastern Europe. There is limited data on the epidemiology and management of this condition in Romania. We
therefore carried out a retrospective survey of MDR-TB care in a hospital based
treatment programme in Ramnicul Valcear (R.C.) Romania (Catchment population
420,000)
Methods: All cases of MDR-TB treated in R.C. Sanatorium over a 40 month
period (1.1.02 - 30.4.05) were identified. Data on demographics, epidemiological
factors, drug sensitivity testing (DST) and adverse drug reactions were collected
in accordance with the WHO DOTS-Plus guidelines.
Results: Thirty nine cases of MDR-TB were identified (26 Male, 7 Female) and
medical notes were available in 33 (92%). The majority 30 (91%) were retired on
ill health grounds or unemployed. Resistance occured whilst on treatment in 31
(93%) cases. HIV testing was carried out in 22 (66%) cases; all were negative.
DST testing was limited in extent and complete results to first and second line
drugs were available in only 12 (36%) of patients. Eight (24%) patients had to
discontinue one or more drugs with adverse drug reactions.
Conclusions: Based on these data, the management of MDR-TB in R.C. Romania
is problematic. There is a need for a more comprehensive DST service. Unlike
other countries in Eastern Europe, HIV co-infection may not be a major co-factor
in the development of MDR-TB. The inicidence of adverse drug reactions was
similar to that reported in other countries.

P2252
Pattern of drug resistance among patients who fail Cat II regimen and
patients who fail standard treatment: is any difference?
Payam Tabarsi, Mehdi Mirsaeidi, Azar Nooraki, Majid Amiri, Mehdi Kazempour,
Davood Mansouri, Mohammad Reza Masjedi, Ali Akbar Velayati. TB and
Respiratory Infections, N.R.I.T.L.D, Tehran, Iran
Background: Treatment failure in TB is defined as continued or recurrently positive cultures in a patient receiving appropriate chemotherapy. There are different
approaches in managing these patients. We compare two approaches in this study.
Material and Method: The study was performed during 2002 2004 in a tertiary
referral center in IRAN. We divided the patients in to two groups. First group
were patients who had treatment failure. (Positive sputum culture >3 months of
treatment or positive sputum smear at 5 months). Second group were patients who
had treated with WHO Cat II regimen and had positive sputum smear at the end

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M ONDAY, S EPTEMBER 4 TH 2006

of treatment. Drug susceptibility test was done for all patients who had positive
culture by proportional method. Then susceptibly patterns were compared between
two groups by SPSS for windows (version 11).
Results: 19 patients in group I and 39 patients in group II were included, there was
no difference between two groups with regard patterns to age, sex and nationality
(P-value> 0.05). In group I, antibiogram were susceptible (15.8%), monodrug
resistant (5.3%), Poly drug resistant (15.8%), MDR (57.9%) and unknown in
one case. In group II antibiogram patterns were susceptible (15.4%), Monodrug
resistant (7.7%), poly drug resistant (5.1%), MDR (51.3%) and unknown in eight
cases. There was no difference between two groups due to MDR pattern (P-value
> .05).
Conclusion: There is no difference in drug resistant pattern between TB treatment
failure group and Cat II regimen failure. it seem that Cat II regimen must be
revised although more study is needed.

P2253
Main indicator evolution of the tuberculosis endemic after 5 years since
DOTS was established in a pilot sector of Bucharest
Cristian I. Didilescu, Elmira Ibraim, Domnica-Ioana Chiotan, Doina Lugoji,
Ruxandra Spataru, Mariana Popescu, Tudor Palaghianu, Ileana Dediu,
Carmen Teoibas. Ambulatory, Institute of Pneumology Marius Nasta,
Bucuresti, Romania
Objective: Study of the main indicator evolution of the TB endemic after 5 years
since the DOTS strategy was established in the Sector 4 of Bucharest.
Method: Use of the tuberculosis register data and of other scientific documents
resulted from the monitoring of the tuberculosis endemic evolution.
Results: A decrease of 5% of the new patients occurred between 2001 (one year
after DOTS establishment) 2005 and of 15% of the relapse risk, the weight of
the last ones being modified insignificantly (11.8%-2001 and 11.3%-2005). 72%
of the new patients recorded in 2005 with pulmonary TB were confirmed bacteriologically. The cases among the infant population diminished from 57.9%ooo ,
the highest level reached (2001) to 11.9%ooo (2005). The therapeutic success rate
in the source cases (pulmonary M+ TB), the 2004 cohort, was situated at 84%.
The TB mortality higher level is maintained (11%ooo ), explained by the numerous
extended forms found in detecting the associated diseases and the social status of
homeless.
Conclusions: Although the main indicators evolution of the TB endemic (Sector 4- Bucharest) is favorable, mainly due to the DOTS strategy establishment,
the increasing rigor in applying all the TB control measurements will contribute
continuously to the improvement of the endemic.

P2254
Efficacy of standard 1-st category regimen of chemotherapy in patients with
smear positive destructive pulmonary tuberculosis in Chernovetskaya Oblast,
Ukraine
Svitlana A. Cherenko 1 , Anna V. Boyko 2 . 1 Tuberculosis, Institute of Tuberculosis
and Pulmonology of Academy of Medical Science of Ukraine, Kiev, Ukraine;
2
Tuberculosis, Bukovinsky State Medical University, Chernovtsy, Ukraine
In the period of DOTS implementation in Ukraine are monitored drug resistance
and studied efficacy of standard regimen of chemotherapy in patients with newly
detected tuberculosis who had no previous history of treatment. In retrospective
clinical study for the period 2002-2004 years we analyzed treatment results in 354
patients with newly detected pulmonary smear positive pulmonary tuberculosis,
who were treated with standard 1-st category regimen (2HRZE(S)4HR) under
direct supervision. We included in this study patients with high adherence level
who completed the treatment. Patient who interrupted the chemotherapy course
or had severe underlying disease such HIV were excluded from analyze. Most of
patients (71,2%) had extended cavitary disease with large cavity (4 cm) 46,5%
or several cavity with different size 24,7%. Pulmonary lesions were bilateral
and diffuse in 79,9% patients. At the and of standard duration of intensive phase
(2 months) smear conversion was achieved in 26,8% of patients. After 3 months
of treatment with intensive phase smear conversion was in 42% of patients. At
the start of 5-th month of treatment 40% of patients were failed and started the
retreatment course. Primary drug resistance was revealed in 15,5% of patients,
included multi drug resistance in 2,6% cases and polyresistance in 6,2%. Drug
resistance and large cavitary lesions occurred in high ratio with treatment failure.
We conclude that 4-component standard regimens have insufficient efficacy in
high burden countries where are a lot of patients with primary drug resistance and
extended cavitary disease.

P2255
Diagnostic of sensitivity mycobacterium tuberculosis strains to isoniazid and
rifampicin by simultaneous identification of mutations in rpoB, katG, inhA
andahpC-oxyR genes with biological microchips
Ksenia Yu. Galkina, Elena Yu. Nosova, Olga I. Scotnicova, Arkadiy M. Moroz.
Moscow Government Health, Scientific and Clinical Antituberculosis Center,
Moscow, Russia

from the 71 patients with primary lung tuberculosis were tested with biological
microchips (TB-BIOCHIP).
It can define 28 most common mutations in the rpoB gene, responsible for resistance to rifampicin (R), 19 mutations in the katG, inhA, ahpC-oxyR genes that
cause the resistance to isoniazid (H). Hybridization on TB-BIOCHIP allows
detecting over 90% of MDR MT strains within 48 hours.
There were no MT strains with resistance only to R. 13 (15,47%) with resistance
to H and 12 (14,30%) MDR MBT strains were revealed. 59 (70,23%) strains were
susceptible to both antituberculosis drugs.
In MT strains were fixed 6 genomic tips (3 for MDR strains and 3 for H-resistant
ones). MDR strains had the most common combination of mutations (Ser531Leu
in rpoB gene and Ser315Thr in katG gene). INH-resistance was due to both
mutations only in katG gene (Ser315Thr), and combination with this one and T15
in inhA gene.
Our results had a good correlation with microbiological investigation of the same
samples and strains.
Thus, the method of biological microchips is high sensitive and specific for express
detection of MDR MT strains. It allows detecting of sensitivity MT strains to R and
H within 48 hours that is very important for choosing the adequate antituberculosis
chemotherapy.

P2256
Present aspects of teenagers tuberculosis (14-18 years) in the 4th sector of
Bucharest, Romania
Ruxandra Delia Spataru, Nicolae Cristian Didilescu. TB and Other Chronic
Diseases, National Institute of Pneumology Marius Nasta, Bucharest,
Romania; TB and Other Chronic Diseases, National Institute of Pneumology
Marius Nasta, Bucharest, Romania
We have analysed 104 cases of teenagers TB (14- 18 years) recorded in the 4th
sector of Bucharest between 2000- 2005. The repartition by sexes was higher in
boys (59 cases). The number of cases at 14, 16 and 17 age group was comparatively, outrunning 20 patients/year.The sources of Tb were discovered in 33,6% of
the cases. The TB diagnosis in 82,7% of the cases was made after the presentation
of the symptomatic patients at the specialist. There were recorded both primary
and secondary forms of TB: hilar adenopathy (20 cases), pleurisy (24), miliary
(1), meningitis (2), caseous pneumonia (1), primary-secondary TB (4), secondary
TB (48), ocular (1), cutaneous (1), peritonitis (1), abdominal adonopathy (1). The
bacteriological confirmation was obtained in 44,2% of the cases.The teenagers
TB is mostly determined by the difficult epidemiological survey of this age group:
26% of the cases were unemployed, 5,7% were ocasional workers and only 68,3%
were educated.The gravity of some anergic conditions associated with TB in 14,4%
of the cases (retarded, HIV+, etc) determined complicated and malign forms of
TB with delays in diagnosis and treatment, resulted in 2 deaths. The succes rate
of the treatment was 92,7%!This is the result of a good compliance of this age
group at the chemotherapy, of the DOTS strategy that started in 2000 and of an
adequate psychological supporting.This clinical and epidemiological data permit
careful survey of the teenagers according with National AntiTB Programme in the
condition of a high level TB endemy in our country.

P2257
Our experience with multiple drug-resistant tuberculosis in Plovdiv Region,
Bulgaria 1999-2004
Vesselin G. Davchev 1 , Anahid A. Torossian 2 , Elizabeta N. Bachiiska 1 , Ivelina
I. Gaidarova 3 , Maria G. Dimitrova 3 . 1 TB Outpatient Department, Municipal
Dispensary for Respiratory Diseases, Plovdiv, Bulgaria; 2 Department of
Respiratory Diseases, Medical University, Plovdiv, Bulgaria; 3 TB Ward,
Municipal Dispensary for Respiratory Diseases, Plovdiv, Bulgaria
The aim of the study is to follow up the patients with Multiple Drug-resistant
Tuberculosis (MDRTB) in Plovdiv Region during the period 1999-2004.
Out of a total number of 540 patients with positive cultures 517 (95, 7%) are
tested for drug resistance with Drug Susceptibility Testing /DST/. 23 of them are
with MDRTB. This group is analyzes by sex, age, ethnic origin, employment,
clinical form of the disease, risk factors, comorbidity. The percentage of patients
who have begun the continuation phase without data about the resistance pattern
is registered. The results of treatment are evaluated and the reasons for failure are
commented.
Results: In 25.9% of the patients with DST resistance to one or more first-line
drugs is registered. The mean percentage of MDRTB is 4.4%. The distribution
of the patients with MDRTB by year of case report is as follows: 1999-4.4%,
2000-6.9%, 2001-5.5%, 2002-1.3%, 2003-1.3%, 2004-6.3%. Treatment results:
cured-21, 7%, death-21, 7%, treatment failure-56, 6%
Conclusions: 1. The mean percentage of MDRTB for the period 1999-2004 is 4.
4%
2. There is a high percentage of treatment failure -56, 6% and death -21, 7%
3. In the group of patients with treatment failure 78% are from minority ethnic
origin (gypsies)
4. The treatment failure is due to noncompliance of the patients, non-conformity to
the results of DST, interrupting of the course because of side effects of the drugs,
structural and financial problems of outpatient follow up.

84 samples and clinical strains of Mycobacterium tuberculosis (MT) obtained

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P2258
Pattern of presentation of tuberculosis and the hospital prevalence of
tuberculosis and human immunodeficiency virus co-infection in University
College Hospital, Ibadan: a review of five years (1998 2002)
Olusoji M. Ige, Olumide M. Sogaolu, A. Ogunlade. Department of Medicine,
University College Hospital, Ibadan, Oyo State, Nigeria; Department of
Medicine, University College Hospital, Ibadan, Oyo State, Nigeria; Department
of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
A 5-year review (1998-2002) was done at the pulmonary unit of the University
College Hospital (UCH), Ibadan, Nigeria to determine the pattern of presentation
of tuberculosis (TB) and the prevalence of TB and human Immunodefiency virus
(HIV) co-infection.
A total of one thousand patients were managed for TB but 777 confirmed as having
TB had their case files analysed. There were 418 males and 359 females giving a
male to female ratio of 1.16:1.00.
Pulmonary tuberculosis (PTB) accounted for 78.6% of the patients seen over the
period, followed by tuberculosis meningitis 7.8% then TB spine 6.8% and that of
the lymph node 4.1%. The other types of TB (Abdomen, pericardial and miliary)
accounted for less than 3%.
The highest number of cases of tuberculosis (27.8%) was in the 20-29 age group
for both male and female followed by those less than 40 years (26.0%). Less than
20% (18.3%) were 40 years old and above. The number of TB cases decreased
sharply from a total of 188 in the year 2000 to 89 in 2002. The decrease in number
was most likely due to the fact that directly observed therapy short course (DOTS)
are now available at other centres within the city and its environs.
Only 180 out of the 640 cases of TB were confirmed as HIV positive giving a
seroprevalence rate of 28.12%. The annual distribution of TB/HIV co-infection
showed a rising trend from 26 cases in 1998 to 42 cases in 2002.

P2259
Analysis of mutations in multiple-drug-resistant m. tuberculosis strains
isolated in Kyrgyzstan
Jainagul T. Isakova 1 , Eleonora U. Usupova 1 , Zoya A. Goncharova 2 , Aleksandra
F. Tumashova 2 , Jumabay K. Kojomkulov 2 , Medet J. Kojomkulov 2 , Tologon
Ch. Chubakov 2 , Avtandil Sh. Alisherov 2 , Almaz A. Aldashev 1 . 1 Laboratory of
Molecular and Cell Biology, Institute of Molecular Biology and Medicine,
Bishkek, Kyrgyzstan; 2 Laboratory of Microbiology, National Centre of
Phthisiology, Bishkek, Kyrgyzstan
Aim: To characterize the rpoB, KatG, inhA and ahpC gene mutations in rifampicin (RIF) and isoniazid (INH) resistant of M. tuberculosis strains isolated
from tuberculosis patients in Kyrgyzstan.
Methods: 278 specimens were obtained from patients with tuberculosis. All these
specimens were analyzed for mutations of rpoB, KatG, inhA and ahpC gene by
biological microchip assay.
Results: 129 samples (46%) were found to be wild type MBT strains (RIF and
INH susceptible) and 149 (54%) samples contained mutations associated with RIF
and INH resistance. Among (149) drug resistant (DR) strains, the single primary
DR to RIF was 7 (4.7%) and INH was 48 (32.3%). Multidrug resistance (MDR)
to RIF+INH was found in 94 (63%) cases. 15 different types of mutations were
identified in 101 RIF-resistant strains. The most common point mutations were
in codon 531 (60%), 526 (19%), 516 (5.5%) and 511 (6.8%). Point mutation
Ser531Leu was at the highest frequency (59%). Other point mutations in codons
533, 522, 513 and 512 occurred less frequently. Resistance to INH found in 142
strains. Prevalence of mutation was found in katG gene - 91%, inhA gene 7%
and ahpC gene -2%. In the katG gene five different mutations were detected:
Ser315Thr-94%, Ser315Asn-3%, Ser315Arg-1%, Ser315Gly- 1% and Ile335Val1%. In the inhA region the only found mutation was inhA T15 (7%). In the ahpC
promoter region - AhpC_9 (1%) and AhpC_12 (1%) mutations were found.
Conclusion: In Kyrgyzstan it is a high prevalence of MDR - 63%. The main cause
of RIF-resistance of MBT is the Ser531Leu mutation of rpoB gene, and Ser315Thr
mutation of katG gene is the main cause of INH- resistance.

P2260
The impact of first symptoms on patient delay in pulmonary tuberculosis
Lea Pehme 1 , Kaja Rahu 2,3 , Mati Rahu 2,3 , Alan Altraja 1 . 1 Department of
Pulmonary Medicine, University of Tartu, Tartu, Estonia; 2 Department of
Epidemiology and Biostatistics, National Institute for Health Development,
Tallinn, Estonia; 3 Estonian Centre of Excellence in Behavioural and Health
Sciences, Tartu-Tallinn, Estonia
Aims: To analyze the impact of firstly developed symptoms on patient delay in
pulmonary tuberculosis (TB) in conditions of negligible HIV infection and free
access to medical care with TB.
Methods: Newly-detected culture-positive patients with pulmonary TB aged =16
years registered in 6 counties of Estonia (26% of the Estonian population) during
20022003 were interviewed. Patient delay, defined as the time interval between
the onset of whatever first TB symptom and the patients referral, was calculated
for each patient, followed by analysis of the delay by first symptoms.
Results: Among the 185 patients included, the overall median patient delay was
79 days (range 0580 days). Patient delay was shortest, when the first symptom
was fever (median 22 days), followed by chest pain (33 days), fatigue (54 days),

shortness of breath (70 days), sweats (77 days), weight loss (79 days), sputum production (81 days), anorexia (98 days), cough (99 days), and cough with hemotysis
(196 days).
The average number of symptoms per patient was 5.5. The four most frequently
occurred first symptoms were cough (39.5%), fatigue (38.4%), fever (16.8%), and
sputum production (14.6%). Roughly half of the patients (53.5%) thought that their
symptoms were caused by common cold and only 14.6% declared their suspicion
of being ill with TB.
Conclusions: The overall patient delay in Estonia is longer than in most published
series. Despite being the most frequently occurring first symptoms, cough and
hemoptysis are associated with the longest patient delay stressing the need for increasing the peoples knowledge of prolonged cough and hemoptysis as symptoms
of pulmonary TB.

P2261
Epidemiologic trends in children with tuberculosis (2001-2005)
Neven Pavlov 1 , Slavica Dragisic-Ivulic 1 , Vesna Pavlov 2 . 1 Pediatric Clinic,
University Hospital Split, Split, Croatia; 2 Department of Neonatology,
University Hospital Split, Split, Croatia
Aim: to compare epidemiologic characteristics of 30 children treated for tuberculosis (Tb) in Pediatric Clinic during 1990-95 (P1), 18 during 1996-2000 (P2,
Pavlov N. et al. Eur Respir J 2001; 18, Suppl 33: 470) and 7 children during
2001-2005 (P3).
Results: frequency of extrapulmonal Tb compared to pulmonal decreased: 25(P1),
38(P2), 17%(P3). The incidence difference in various age groups dimished: age
0-4 y: 43(P1), 50(P2) and 29%(P3). The percentage of patients found by preventive
measures increased (contact with Tb patient, positive PPD test): 40(P1) and 39(P2)
but 100% in P3. PPD test was negative in 13(P1), 22 (P2) and 0% of P3 patients,
equal and more than 15 mm in 30(P1), 50(P2) and 86%(P3) and even vesicular
in 43(P1), 22(P2) and 29%(P3). Percentage of positive bacteriology cultures decreased: 50(P1), 39(P2) and 14% P3 children. Mycobacterium tuberculosis (My
Tb) was isolated mainly from gastric lavage (28 P2, 14% P3), once from bronchoscopy specimen (P2, P3) and expectorated sputum (P2, P3). We had 3 cases
of smear-positive acid-fast bacilli (bronchoscopy specimen, gastric lavage): 2(P2),
1(P3). Isolated My Tb was resistant to isoniasid in 3 (P1) and 1 (P2) patient, but
not in P3. Radiographic manifestations were found in 90(P1), 78(P2) and 71%(P3)
patients: specific parenchymal lesions with lymphadenopathy 30(P1), 28(P2) and
29% (P3), only parenchymal lesions 23(P1), 33(P2) and 57%(P3).
Conclusion: The most noticeable facts are decreased incidence of Tb in P3 children
and decreased percentage of positive bacteriology cultures.

P2262
Factors associated with changing diagnosis of tuberculosis in Taipei
Chen-Yuan Chiang 1 , Kwen-Tay Luh 2 , Donald A. Enarson 1 , Tao-Ping Lin 2 ,
Yi-Chun Wu 3 , Chiao-Yamg Lu 4 . 1 Department of Scientific Activities,
International Union Against Tuberculosis and Lung Disease, Paris, France;
2
National Tuberculosis Association, Taipei, Taiwan; 3 Center for Disease Control,
Taipei, Taiwan; 4 Department of Health, Taipei City, Taipei, Taiwan
Objective: To investigate factors associated with changing diagnosis of tuberculosis by clinicians after prescribing antituberculosis treatment in Taipei.
Material and Method: All tuberculosis cases reported in 2003 in Taipei were
obtained from Center for Disease Control, Taipei, Taiwan, and investigated by
consulting medical charts at reporting health institutions.
Results: Of the 2018 tuberculosis cases reported in Taipei City in 2003, diagnosis
and treatment data of 1973 (97.8%) cases were obtained from medical charts.
Of the 1973 patients, 1716 (87.0%) have been prescribed with antituberculosis
treatment. Of the 1716 patients, 1110 (64.7%) were male, 831 (48.4%) aged
65 years or more, 1432 (83.5%) were pulmonary tuberculosis. Extrapulmonary
tuberculosis cases were more likely to have diagnosis changed than pulmonary
tuberculosis cases (20.7% vs 15.8%, p=0.039). Of the 1432 pulmonary tuberculosis
patients, smear positive, culture positive for M. tuberculosis and not visiting other
health institutions after starting antituberculosis treatment were less likely to have
diagnosis changed after controlling for other variables.
Conclusion: A substantial proportion of tuberculosis cases had diagnosis changed
after being prescribed with antituberculosis drugs. The quality in the diagnosis of
bacteriologically negative tuberculosis needs to be addressed.

P2263
Effect of fluoroquinolones on microbiologic outcome and survival in the
treatment of multidrug-resistant tuberculosis
Tlay Trn, Kemal Tahaoglu, Ipek zmen, Gkay Gngr, Tlin Sevim,
Gliz Ata, Emine Aksoy, Gazi Gndz. Pulmonology, Sreyyapasa Centre for
Chest Diseases and Thoracic Surgery, Istanbul, Turkey
Background: We analyzed data on 252 patients treated for multidrug-resistant
tuberculosis at our centre in Istanbul, Turkey, between April 1992 and January
2004.
Methods: This study evaluates the effect of fluoroquinolones on microbiologic
outcome and survival in 252 patients, who were resistant to a mean number of 4.1
drugs. Rates of survival were estimated using the Kaplan-Meier method.

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Results: Of the patients, 48 were females and 204 were males with a total age
range of 14 to 68 years. The patients received a mean of 5.4 (range, 3 to 9) drugs.
Regimens included one fluoroquinolone in 215 cases (85.3 percent). Patients who
received fluoroquinolone had a higher initial favourable treatment response than
patients who did not receive (OR 4.6, CI 1.9 to 10.8, p=0.001). Long-term treatment success was significantly higher in cases administered with fluoroquinolone,
than cases that were not (OR 11.5, CI 5.1 to 25.8, p<0.001). In cases administered
with fluoroquinolone, the cumulative survival rates were 95.3%, and in cases that
were not so administered, it was and 78.3%. Survival rates showed a statistically
significant difference between the two groups (p=0.0002)
Conclusion: Our study demonstrated that a high initial favourable treatment response rate was achieved by including fluoroquinolone in the regimen and also
that, in this situation, high long-term treatment success and survival rates could be
achieved.

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