Tuberkulose
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Guidelines
1 Tuberkulose - diagnostik og behandling (2018) I 2000 udgav Dansk Lungemedicinsk Selskab ”Det Nationale Tuberkuloseprogram og forslag til klinisk håndtering af TB”. Publikationen blev opdateret i 2010 af en arbejdsgruppe bestående af repræsentanter udpeget af Dansk Lungemedicinsk Selskab, Dansk Selskab for Infektionsmedicin, Dansk Pædiatrisk Selskab, Dansk Selskab for Klinisk Mikrobiologi og Statens Serum Institut.
Links
1 Tuberkulose behandlingsskema
2 Region Hovedstadens vejledning om diagnostik og behandling af tuberkulose
3 Region Hovedstadens vejledning om smitteopsporing
4 SSI's overvågning af tuberkulose i Danmark
5 Epi-Nyt om tuberkulose i Danmark (2016)
6 Sundhedsstyrelsens vejledning om forebyggelse af tuberkulose (2015)
7 ECDC Tuberculosis surveillance and monitoring in Europe (2017)
8 WHO Global tuberculosis report (2017)
9 WHO Tuberculosis surveillance and monitoring report in Europe (2017)
10 WHO Towards tuberculosis elimination (2014): an action framework for low-incidence countries
11 WHO Latent TB Infection (2018)
Nye artikler
1 Neuropsychiatric toxicity and cycloserine concentrations during treatment for multidrug-resistant tuberculosis Richard Court, Chad M. Centner, Maxwell Chirehwa, Lubbe Wiesner, Paolo Denti, Nihal de Vries, Joseph Harding, Tawanda Gumbo, Gary Maartens, Helen McIlleron International Journal of Infectious Diseases, 5.03.2021 Tilføjet 05.03.2021 15:38D-4-amino-3-isoxazolidinone, or D-cycloserine (cycloserine) was first discovered and synthesized by Hidy et al almost 70 years ago (Hidy et al., 1955). The neuropsychiatric toxicity (including depression and psychosis) was first reported with the earliest known use of cycloserine, and subsequent early treatment reports (Kendig et al., 1956; Murray, 1956). Cycloserine-associated peripheral neuropathy has been less frequently reported (Kendig et al., 1956; Murray, 1956; Desmeules et al., 1957; Conradie et al., 2014). Læs mere Tjek på PubMed2 Sputum smear grading and associated factors among bacteriologically confirmed pulmonary drug-resistant tuberculosis patients in Ethiopia BMC Infectious Diseases, 5.03.2021 Tilføjet 05.03.2021 07:55 Abstract Background The sputum smear bacilliary load is a fundamental indicator of the level of infectiousness in DR-TB patients. However, evidence on DR-TB sputum smear grading and its factors in the study setting is limited. This study was aimed to determine the level of sputum smear grading and associated factors among DR-TB patients in Ethiopia. Methods This was an institution based cross-sectional study on 520 bacteriological confirmed pulmonary DR-TB patients from September 2010 to December 2017 in the northwest Ethiopia. Epidata 4.2.00 and SPSS 20 were used for data entry and management, respectively. Ordinary logistic regression was fitted. A cut of p-value less than 0.05 in the multivariable ordinary logistic regression was considered to declare statistically significant variables. Results Of all 520 bacteriological confirmed pulmonary DR-TB patients; 34.42% had 3+, 15.77% had 2+, 18.27% had 1+, 15.19% had scanty, and 16.35% had negative sputum smear grading results. The odds of having higher sputum smear grades were significantly associated with the patient’s educational status of secondary (Adjusted Odds Ratio (AOR) = 0.43, 95% Confidence Interval (CI): 0.21, 0.89), body mass index of 16 to 18.49 kg/m2 (AOR = 1.81, 95%CI: 1.16, 2.84), and TB treatment history of two and more times (AOR = 1.78, 95%CI: 1.24, 2.55). Conclusions More than a third of the bacteriological confirmed pulmonary DR-TB patients in the study setting was highly infectious with the highest bacillary load. The odds of having a high bacillary load were significantly associated with the patient’s TB treatment history, nutritional, and educational status. Læs mere Tjek på PubMed3 Genomic epidemiological analysis identifies high relapse among individuals with recurring tuberculosis and provides evidence of household recent TB transmission in Ghana Prince Asare, Stephen Osei-Wusu, Nyonuku Akosua Baddoo, Edmund Bedeley, Isaac Darko Otchere, Daniela Brites, Chloé Loiseau, Adwoa Asante-Poku, Diana Ahu Prah, Sonia Borrell, Miriam Reinhard, Michael Amo Omari, Audrey Forson, Kwadwo Ansah Koram, Sebastien Gagneux, Dorothy Yeboah-Manu International Journal of Infectious Diseases, 2.03.2021 Tilføjet 04.03.2021 19:514 Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Brunei Darussalam: A 6-year retrospective cohort study Nurfakhrina Omar, Justin Wong, Kyaw Thu, Md Fathi Alikhan, Liling Chaw International Journal of Infectious Diseases, 18.02.2021 Tilføjet 04.03.2021 19:515 Treatment outcomes of pregnant women with drug resistant tuberculosis in Uganda: a retrospective review of 18 cases Joseph Baruch Baluku, Felix Bongomin International Journal of Infectious Diseases, 18.02.2021 Tilføjet 04.03.2021 19:516 Tuberculosis among children and adolescents in Rio de Janeiro, Brazil – focus on Extrapulmonary disease Márcia Cortez Bellotti de Oliveira, Clemax Couto Sant’Anna, Ronir Luiz Raggio, Afrânio Lineu Kritski International Journal of Infectious Diseases, 14.02.2021 Tilføjet 04.03.2021 19:51To compare the socio-demographic, clinical, and diagnostic characteristics and treatment outcomes between extrapulmonary tuberculosis (EPTB) and pulmonary tuberculosis (PTB) in children and adolescents in Rio de Janeiro, a high TB burden Brazilian city. Læs mere Tjek på PubMed7 Tuberculosis in persons with sudden unexpected death in Cape Town, South Africa Muhammad Osman, Janette Verster, Johan J. Dempers, Karen Du Preez, Arne von Delft, Rory Dunbar, Alex Welte, Pren Naidoo, Anneke C. Hesseling International Journal of Infectious Diseases, 11.02.2021 Tilføjet 04.03.2021 19:518 Diagnostic accuracy of Xpert MTB/RIF assay for bone and joint tuberculosis using tissue specimens Zibo Zhou, Yan Zheng, Leiming Wang International Journal of Infectious Diseases, 11.02.2021 Tilføjet 04.03.2021 19:519 Raltegravir in patients with tuberculosis Anton Pozniak, Graeme Meintjes Lancet Infectious Diseases, 3.03.2021 Tilføjet 04.03.2021 19:51Treatment of patients with tuberculosis and HIV infection is complex, with pill burden and treatment adherence presenting major challenges. Rifampicin is a potent inducer of hepatic cytochrome P450 and uridine diphosphate glucuronosyl transferase 1A1 enzymes and the drug efflux pump P-glycoprotein, with potential for major drug–drug interactions with many antiviral drugs. Læs mere Tjek på PubMed10 Standard dose raltegravir or efavirenz-based antiretroviral treatment for patients co-infected with HIV and tuberculosis (ANRS 12 300 Reflate TB 2): an open-label, non-inferiority, randomised, phase 3 trial Nathalie De Castro, Olivier Marcy, Corine Chazallon, Eugène Messou, Serge Eholié, Jean-Baptiste N'takpe, Nilesh Bhatt, Celso Khosa, Isabel Timana Massango, Didier Laureillard, Giang Do Chau, Anaïs Domergue, Valdilea Veloso, Rodrigo Escada, Sandra Wagner Cardoso, Constance Delaugerre, Xavier Anglaret, Jean-Michel Molina, Beatriz Grinsztejn, ANRS 12300 Reflate TB2 study group Lancet Infectious Diseases, 3.03.2021 Tilføjet 04.03.2021 19:51In patients with HIV given tuberculosis treatment, non-inferiority of raltegravir compared with efavirenz was not shown. Raltegravir was well tolerated and could be considered as an option, but only in selected patients. Læs mere Tjek på PubMed11 Tuberculosis care does not end at treatment completion— a perspective from tuberculosis survivors Ingrid Schoeman, Zolelwa Sifumba Lancet Infectious Diseases, 26.02.2021 Tilføjet 04.03.2021 19:51Tuberculosis survivors need comprehensive care to increase their quality of life beyond the completion of tuberculosis treatment. Socioeconomic and medical challenges are faced by many patients after being cured from tuberculosis.1 A systematic review and meta-analysis by Kamila Romanowski and colleagues2 found the force of mortality for tuberculosis survivors to be 2·91 (95% CI 2·21–3·84) times higher than in those who had never had tuberculosis. Post-tuberculosis lung damage negatively impacts many tuberculosis survivors' quality of life. Læs mere Tjek på PubMed12 Quantifying the global number of tuberculosis survivors: a modelling study Peter J Dodd, Courtney M Yuen, Shamanthi M Jayasooriya, Marieke M van der Zalm, James A Seddon Lancet Infectious Diseases, 26.02.2021 Tilføjet 04.03.2021 19:51The number of tuberculosis survivors alive in 2020 is more than ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors. Læs mere Tjek på PubMed13 Thalidomide Use for Complicated Central Nervous System Tuberculosis in Children: Insights From an Observational Cohort van Toorn R, Solomons R, Seddon J, et al. Clinical Infectious Diseases, 6.12.2020 Tilføjet 04.03.2021 19:51AbstractBackgroundMuch of the neurological sequelae of central nervous system (CNS) tuberculosis (TB) is due to an excessive cytokine-driven host-inflammatory response. Adjunctive corticosteroids, which reduce cytokine production and thus dampen the inflammation, improve overall survival but do not prevent morbidity. This has prompted investigation of more targeted immunomodulatory agents, including thalidomide.MethodsWe describe a retrospective cohort of 38 children consecutively treated with adjunctive thalidomide for CNS TB–related complications over a 10-year period.ResultsThe most common presenting symptom was focal motor deficit (n = 16), followed by cranial nerve palsies and cerebellar dysfunction. Three of the 38 children presented with large dural-based lesions, manifesting as epilepsia partialis continua (EPC), 4 presented with blindness secondary to optochiasmatic arachnoiditis, and 2 children developed paraplegia due to spinal cord TB mass lesions. Duration of adjunctive thalidomide therapy (3–5 mg/kg/day) varied according to complication type. In children compromised by TB mass lesions, the median treatment duration was 3.9 months (interquartile range [IQR], 2.0–5.0 months), whereas in children with optic neuritis it was 2.0 months (IQR, 1.3–7.3 months) and in EPC it was 1.0 months (IQR, 1–2.5 months). Satisfactory clinical and radiological response was observed in 37 of the children. None of the children experienced rashes, hepatitis, or hematologic derangements or complained of leg cramps.ConclusionsThis study is the largest cohort of adult or pediatric patients treated with adjunctive thalidomide for CNS TB–related complications. The drug has proved to be safe and well tolerated and appears to be clinically efficacious. The potential role of thalidomide or analogues in the treatment of other tuberculous meningitis–related complications requires further exploration. Læs mere Tjek på PubMed14 Higher Levels of Alcohol Use Are Associated With Latent Tuberculosis Infection in Adults Living With Human Immunodeficiency Virus Puryear S, Fatch R, Beesiga B, et al. Clinical Infectious Diseases, 6.05.2020 Tilføjet 04.03.2021 19:51AbstractWe assessed associations between hazardous alcohol use and latent tuberculosis infection (LTBI) among adults living with human immunodeficiency virus (HIV) in Uganda. We compared tuberculin skin test positivity across medium, high, and very-high alcohol use levels, classified by AUDIT-C scores. In multivariable analysis, very high use was associated with LTBI (adjusted odds ratio 1.61, 95% confidence interval: 1.03–2.50). Læs mere Tjek på PubMed15 Yield, Efficiency, and Costs of Mass Screening Algorithms for Tuberculosis in Brazilian Prisons Santos A, de Oliveira R, Lemos E, et al. Clinical Infectious Diseases, 17.02.2020 Tilføjet 04.03.2021 19:51AbstractBackgroundTuberculosis (TB) is a major cause of morbidity and mortality among incarcerated populations globally. We performed mass TB screening in 3 prisons and assessed yield, efficiency, and costs associated with various screening algorithms.MethodsBetween 2017 and 2018, inmates from 3 prisons in Brazil were screened for TB by symptom assessment, chest radiography, sputum testing by Xpert MTB/RIF fourth-generation assay, and culture. Chest radiographs were scored by an automated interpretation algorithm (Computer-Aided Detection for Tuberculosis [CAD4TB]) that was locally calibrated to establish a positivity threshold. Four diagnostic algorithms were evaluated. We assessed the yield (percentage of total cases found) and efficiency (prevalence among those screened) for each algorithm. We performed unit costing to estimate the costs of each screening or diagnostic test and calculated the cost per case detected for each algorithm.ResultsWe screened 5387 prisoners, of whom 214 (3.9%) were diagnosed with TB. Compared to other screening strategies initiated with chest radiography or symptoms, the trial of all participants with a single Xpert MTB/RIF sputum test detected 74% of all TB cases at a cost of US$249 per case diagnosed. Performing Xpert MTB/RIF screening tests only on those with symptoms had a similar cost per case diagnosed (US$255) but missed 35% more cases (73 vs 54) as screening all inmates.ConclusionsIn this prospective study in 3 prisons in a high TB burden country, we found that testing all inmates with sputum Xpert MTB/RIF was a sensitive approach, while remaining cost-efficient. These results support use of Xpert MTB/RIF for mass screening in TB-endemic prisons. Læs mere Tjek på PubMed16 Detecting Tuberculosis in Prisons: Switching Off the Disease at Its Source Woodman M, Grandjean L. Clinical Infectious Diseases, 17.02.2020 Tilføjet 04.03.2021 19:5117 Patient pathway analysis of tuberculosis diagnostic delay: a multicentre retrospective cohort study in China Lu Zhang, Tao-Ping Weng, Hong-Yu Wang, Feng Sun, Yuan-Yuan Liu, Ke Lin, Zhe Zhou, Yuan-Yuan Chen, Yong-Guo Li, Ji-Wang Chen, Li-Jun Han, Hui-Mei Liu, Fu-Li Huang, Cui Cai, Hong-Ying Yu, Wei Tang, Zheng-Hui Huang, Long-Zhi Wang, Lei Bao, Peng-Fei Ren, Guo-Fang Deng, Jian-Nan Lv, Yong-Lan Pu, Fan Xia, Tao Li, Qun Deng, Gui-Qing He, Yang Li, Wen-Hong Zhang Clinical Microbiology and Infection, 5.01.2021 Tilføjet 04.03.2021 19:51Delay in diagnosis of tuberculosis (TB) is an important but under-appreciated problem. Our study aimed to analyse the patient pathway and possible risk factors of long diagnostic delay (LDD). Læs mere Tjek på PubMed18 Detection of Mycobacterium tuberculosis complex in pulmonary and extrapulmonary samples with the FluoroType MTBDR assay Erik Svensson, Dorte Bek Folkvardsen, Erik Michael Rasmussen, Troels Lillebaek Clinical Microbiology and Infection, 5.01.2021 Tilføjet 04.03.2021 19:51Rifampicin (RIF) and isoniazid (INH) are the two most effective first-line antibiotic drugs for the treatment of tuberculosis (TB). The new FluoroType MTBDR (FT-MTBDR) real-time PCR is intended to detect INH and RIF resistance mutations as a second step following a primary Mycobacterium tuberculosis complex (MTBC) PCR. Here we evaluate the feasibility of the FT-MTBDR assay to detect simultaneously MTBC-specific DNA as well as to detect potential INH and RIF resistance through analysing inhA promotor, katG and rpoB sequences in one PCR reaction. Læs mere Tjek på PubMed19 Extrapulmonary tuberculosis among migrants in Europe, 1995 to 2017 Sally E. Hayward, Kieran Rustage, Laura B. Nellums, Marieke J. van der Werf, Teymur Noori, Delia Boccia, Jon S. Friedland, Sally Hargreaves Clinical Microbiology and Infection, 18.12.2020 Tilføjet 04.03.2021 19:51The proportion of tuberculosis (TB) cases occurring in migrants in Europe is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality, yet its extent in migrant populations is unclear. We assessed patterns of extrapulmonary TB in migrants across the European Union (EU)/European Free Trade Association (EFTA). We investigated the proportion of extrapulmonary TB cases among migrants versus non-migrants, and variations by specific site of disease, reporting European region, and migrant region of origin. Læs mere Tjek på PubMed20 In-depth analysis of a mixed Mycobacterium tuberculosis infection involving a multidrug-resistant strain and a susceptible strain Estefanía Abascal, Marta Herranz, María Jesús Ruiz Serrano, Francisco Fernández-González, Patricia Muñoz, Eduardo Gotuzzo, Darío García de Viedma Clinical Microbiology and Infection, 29.09.2020 Tilføjet 04.03.2021 19:51Within a mycobacterial interspersed repetitive units–variable number tandem repeats (MIRU-VNTR) -based molecular epidemiology programme run on prisoners transferred from Peruvian prisons to a Spanish prison, we identified a mixed infection in one individual [1]. After segregating the two strains by serial dilutions on agar plates of the cultured isolates and single-colony analysis supported by MIRU-VNTR analysis, we detected the coexistence of a susceptible and a multidrug-resistant (MDR) strain (see Supplementary material, Table S1). Læs mere Tjek på PubMed |
Referencer
1 Tuberculosis. N Engl J Med 2013; 368(8):745-55 2 Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis 2002; 8(7):679-84
Lillebaek T, Andersen AB, Dirksen A, Smith E, Skovgaard LT, Kok-Jensen A
Immigration from areas of high incidence is thought to have fueled the resurgence of tuberculosis (TB) in areas of low incidence. To reduce the risk of disease in low-incidence areas, the main countermeasure has been the screening of immigrants on arrival. This measure is based on the assumption of a prompt decline in the incidence of TB in immigrants during their first few years of residence in a country with low overall incidence. We have documented that this assumption is not true for 619 Somali immigrants reported in Denmark as having TB. The annual incidence of TB declined only gradually during the first 7 years of residence, from an initial 2,000 per 100,000 to 700 per 100,000. The decline was described by an exponential function with a half-time of 5.7 (95% confidence interval 4.0 to 9.7) years. This finding seriously challenges the adequacy of the customary practice of screening solely on arrival. PMID: 120954343 European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J 2002; 19(4):765-75
Broekmans JF, Migliori GB, Rieder HL, Lees J, Ruutu P, Loddenkemper R, Raviglione MC,
As countries approach the elimination phase of tuberculosis, specific problems and challenges emerge, due to the steadily declining incidence in the native population, the gradually increasing importance of the importation of latent tuberculosis infection and tuberculosis from other countries and the emergence of groups at particularly high risk of tuberculosis. Therefore, a Working Group of the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Royal Netherlands Tuberculosis Association (KNCV) have developed a new framework for low incidence countries based on concepts and definitions consistent with those of previous recommendations from WHO/IUATLD Working Groups. In low-incidence countries, a broader spectrum of interventions is available and feasible, including: 1) a general approach to tuberculosis which ensures rapid detection and treatment of all the cases and prevention of unnecessary deaths; 2) an overall control strategy aimed at reducing the incidence of tuberculosis infection (risk-group management and prevention of transmission of infection in institutional settings) and 3) a tuberculosis elimination strategy aimed at reducing the prevalence of tuberculosis infection (outbreak management and provision of preventive therapy for specified groups and individuals). Government and private sector commitment towards elimination, effective case detection among symptomatic individuals together with active case finding in special groups, standard treatment of disease and infection, access to tuberculosis diagnostic and treatment services, prevention (e.g. through screening and bacille Calmette-Guéria immunization in specified groups), surveillance and treatment outcome monitoring are prerequisites to implementing the policy package recommended in this new framework document. PMID: 119990074 Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345(15):1098-104
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, Braun MM
Infliximab is a humanized antibody against tumor necrosis factor alpha (TNF-alpha) that is used in the treatment of Crohn's disease and rheumatoid arthritis. Approximately 147,000 patients throughout the world have received infliximab. Excess TNF-alpha in association with tuberculosis may cause weight loss and night sweats, yet in animal models it has a protective role in the host response to tuberculosis. There is no direct evidence of a protective role of TNF-alpha in patients with tuberculosis. PMID: 115965895 Risk of Mycobacterium tuberculosis transmission in a low-incidence country due to immigration from high-incidence areas. J Clin Microbiol 2001; 39(3):855-61
Lillebaek T, Andersen AB, Bauer J, Dirksen A, Glismann S, de Haas P, Kok-Jensen A
Does immigration from a high-prevalence area contribute to an increased risk of tuberculosis in a low-incidence country? The tuberculosis incidence in Somalia is among the highest ever registered. Due to civil war and starvation, nearly half of all Somalis have been forced from their homes, causing significant migration to low-incidence countries. In Denmark, two-thirds of all tuberculosis patients are immigrants, half from Somalia. To determine the magnitude of Mycobacterium tuberculosis transmission between Somalis and Danes, we analyzed DNA fingerprint patterns of isolates collected in Denmark from 1992 to 1999, comprising >97% of all culture-positive patients (n = 3,320). Of these, 763 were Somalian immigrants, 55.2% of whom shared identical DNA fingerprint patterns; 74.9% of these were most likely infected before their arrival in Denmark, 23.3% were most likely infected in Denmark by other Somalis, and 1.8% were most likely infected by Danes. In the same period, only 0.9% of all Danish tuberculosis patients were most likely infected by Somalis. The Somalian immigrants in Denmark could be distributed into 35 different clusters with possible active transmission, of which 18 were retrieved among Somalis in the Netherlands. This indicated the existence of some internationally predominant Somalian strains causing clustering less likely to represent recent transmission. In conclusion, M. tuberculosis transmission among Somalis in Denmark is limited, and transmission between Somalis and Danes is nearly nonexistent. The higher transmission rates between nationalities found in the Netherlands do not apply to the situation in Denmark and not necessarily elsewhere, since many different factors may influence the magnitude of active transmission. PMID: 112303956 Genome-sequence-based fluorescent amplified-fragment length polymorphism analysis of Mycobacterium tuberculosis. J Clin Microbiol 2000; 38(3):1121-6
Goulding JN, Stanley J, Saunders N, Arnold C
The whole-genome fingerprinting technique, fluorescent amplified-fragment length polymorphism (FAFLP) analysis, was applied to Mycobacterium tuberculosis. Sixty-five clinical isolates were analyzed to determine the value of FAFLP as a stand-alone genotyping technique and to compare it with the well-established IS6110 typing system. The genome sequence of M. tuberculosis strain H37Rv (S. T. Cole et al., Nature 393:537-544, 1998) was used to model computer-generated informative primer combination(s), and the precision and reproducibility of FAFLP were evaluated by comparing the results of in vitro and computer-generated experiments. Multiplex FAFLP was used to increase resolving power in a predictable and systematic fashion. FAFLP analysis was broadly congruent with IS6110 typing for those strains with multiple IS6110 copies. It was also able to resolve an epidemiologically unlinked group of strains with only one copy of IS6110; up to 10% of clinical isolates may fall into this category. For certain epidemiological investigations, it was concluded that a combination of FAFLP and IS6110 typing would give higher resolution than would either alone. FAFLP data were digital, precise, reproducible, and suitable for rapid electronic dissemination, manipulation, interlaboratory comparison, and storage in national or international epidemiological databases. Because FAFLP samples and analyzes base substitution across the genome as a whole, FAFLP could generate new information about the microevolution of the M. tuberculosis complex. PMID: 106990067 Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999; 282(7):677-86
Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC
To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997. PMID: 105177228 [Tuberculosis in Denmark 1972-1996]. Ugeskr Laeger 1999; 161(23):3452-7
Poulsen S, Rønne T, Kok-Jensen A, Bauer JO, Miörner H
The present study is based on notified cases of tuberculosis (TB) in the National tbc. register 1972-1996. A decline in Tb incidence was seen from 1972 and until the mid-1980's. Subsequently the trend has reversed due to an increasing number of TB cases in foreigners. In 1996, 60% of all cases of TB in Denmark were found in foreigners reflecting the rising number of refugees and their families arriving in Denmark from highly endemic areas, mainly Somalia. Among native Danes the TB incidence fell from 14 per 100,000 in 1972 to 4 per 100,000 in the 1980's and stabilized at this very low level. The unchanged incidence in Danes covers a falling incidence in the older and a rising incidence in the younger and middle-aged adult population, mainly in the capital. Approximately half of the cases occur in high-risk groups. The TB-epidemic is close to elimination in the indigenous Danish population, but the disease is maintained at a low level probably due to increased patient and doctor delay and resulting microepidemics primarily in high-risk populations. PMID: 103883539 Classics in infectious diseases. The etiology of tuberculosis: Robert Koch. Berlin, Germany 1882. Rev Infect Dis ; 4(6):1270-4 |
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