Outcome of tuberculosis treatment at the pulmonary - tuberculosis department of A.U.TH. during the three-year period 2012-2014
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Pulmonary-Tuberculosis Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Exohi, Thessaloniki, Greece
Katerina Manika   

Pulmonary-Tuberculosis Department, Aristotle University of Thessaloniki, “G. Papanikolaou”, 57010, Exohi, Thessaloniki, Greece
Pneumon 2017;30(3):141–150
Tuberculosis remains a serious threat to public health and one of the leading causes of death among infectious diseases. Monitoring treatment outcome is necessary in order to assess the effectiveness of the therapeutic intervention and to identify possible obstacles to disease control. In that setting outcome is an important indicator of the effectiveness of TB control programs.

Material and Methods:
This is a retrospective study of TB patients registered at the Department of Pulmonary Medicine Aristotle University of Thessaloniki (AUTH), in the period from January 1st, 2012 to December 31st, 2014.

89 patients aged 49.5±19.20 years were recorded. 67.5 % were men. 68.5% of patients were of Greek origin and 91% suffered from pulmonary TB. In 78.7% of patients the diagnosis was confirmed microbiologically. 11.2% presented with monoresistance or polydrug resistance to anti-TB drugs. The positive outcome rate of the TB treatment was 67.5%, of which 38.2% were cured and 29.3% completed the treatment. The outc ome was negative in 32.5% of patients and rates that corresponded specifically to death, treatment failure, loss to follow-up and lack of evaluation were 4.5%, 1.1%, 2.2% and 24.7% respectively.

The positive outcome rate of TB among patients was lower than the WHO global target of 85%. There is a clear need for a comprehensive management of problems in TB monitoring in Greece, both in terms of its impact and its outcome.

There are no conflicts of interest of all authors.
Without any potential funding or grant support of the work described.
Sulis G, Roggi A, Matteelli A, et al. Tuberculosis: Epidemiology and Control. Mediterranean Journal of Hematology and Infectious Diseases 2014; 6:e2014070.
World Health Organization- WHO. Global tuberculosis report 2016.
European Centre for Disease Prevention and Control/WHO Regional Office for Europe (ECDC/WHO EURO). Tuberculosis surveillance and monitoring in Europe 2017.
European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2016. Stockholm: ECDC; 2016.
Jelastopulu E, Alexopoulos EC, Venieri D, et al. Substantial underreporting of tuberculosis in West Greece: implications for local and national surveillance. Euro Surveill 2009; 14:pii:19152.
Lytras T, Spala G, Bonovas S, et al. Evaluation of Tuberculosis Underreporting in Greece through Comparison with AntiTuberculosis Drug Consumption. Dowdy DW, ed. PLoS ONE. 2012; 7:e50033.
Ibarz-Pavón AB, Papaventsis D, Kalkouni R, et al. Pilot study of the completeness of notification of adult tuberculosis in Athens, Greece. Int J Tuberc Lung Dis 2016; 20:920-5.
World Health Organization (WHO). TB: a global emergency, WHO report on the TB epidemic. WHO/TB/94.177. Geneva, 1994.
World Health Organization (WHO). WHO tuberculosis programme: framework for effective tuberculosis control. WHO/ TB/94.179. Geneva, 1994.
International Union Against Tuberculosis and Lung Disease (IUATLD). Tuberculosis Guide for Low Income Countries, 4th ed. IUATLD, Paris, 1996.
World Health Organization (WHO)/Stop-TB Partnership. The Global Plan to Stop TB: Phase 1: 2001–2005. WHO/CDS/ STB/2001.16. WHO, Geneva, 2001.
World Health Organization (WHO). Global strategy and targets for tuberculosis prevention, care and control beyond 2015. Geneva, 2013.
World Health Organization (WHO). Global Tuberculosis Report 2013. Geneva, 2013.
World Health Organization: WHO Fact sheets on tuberculosis. Fact sheet N°104. Reviewed March 2016.
World Health Organization (WHO). Global Tuberculosis Report 2015.
World Health Organization. Treatment of Tuberculosis Guidelines. 4th editionWHO/HTM/TB/2009.40. Geneva: WHO; 2009.
Karo Β, Hauer Β, Hollo V, van der Werf MJ, Fiebig L, Haas W. Tuberculosis treatment outcome in the European Union and Europen E conomic Area: an analysis of surveillance data from 2001-2011. Euro Surveill 2015; 20:pii:30087. doi: 10.2807/1560- 7917.ES.2015.20.49.30087.
Moschota K, 2016. Sanatorium Asvestochori where the present meets the past. Thessaloniki.
World Health Organization (WHO). Definitions and reporting framework for tuberculosis – 2013 revision (updated December 2014).
Centers for Disease Control and Prevention (CDC). Reported Tuberculosis in the United States, 2013. Atlanta: CDC; October 2014.
Public Health Agency of Canada. Tuberculosis in Canada 2012- Pre-Release. Ottawa (Canada): Minister of Public Works and Government Services Canada; 2014.
Sengul A, Akturk UA, Aydemir Y, et al. Factors affecting successful treatment outcomes in pulmonary tuberculosis: a single-center experience in Turkey, 2005-2011. J Infect Dev Ctries 2015; 9:821-8.
Vasankari T, Holmström P, Ollgren J, et al. Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC Public Health 2007; 7:291.
Lefebvre N, Falzon D. Risk factors for death among tuberculosis cases: analysis of European surveillance data. Eur Respir J. 2008; 31:1256-60.
Hauer B, Brodhun B, Altmann D et al. Tuberculosis in the elderly in Germany. Eur Respir J 2011; 38:467-70.
Kolappan C, Subramani R, Kumaraswami V, et al. Excess mortality and risk factors for mortality among a cohort of TB patients from rural south India. Int J Tuberc Lung Dis 2008;12:81-6.
Babalik A, Kilicaslan Z, Caner SS, et al. A registry-based cohort study of pulmonary tuberculosis treatment outcomes in Istanbul, Turkey. Jpn J Infect Dis 2013; 66:115-20.
Heunis JC, Kigozi NG, Chikobvu P, et al. Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province. BMC Public Health 2017;17:38.
Rajagopalan S. Tuberculosis and aging: a global health problem. Clin Infect Dis 2001; 33:1034-9.
Packham S. Tuberculosis in the elderly. Gerontology 2001; 47:175-9.
Zevallos M, Justman JE. Tuberculosis in the elderly. Clin Geriatr Med 2003; 19:121-38.
Ohmori M, Wada M, Yoshiyama T, et al. Factors related to early case detection of tuberculosis in health service facilities for the elderly. Kekkaku 2003; 78:435-42.
Acuña-Villaorduña C, Ayakaka I, Dryden-Peterson S, et al. High mortality associated with retreatment of tuberculosis in a clinic in Kampala, Uganda: A retrospective study. Am J Trop Med Hyg 2015; 93:73–5.
Liew SM, Khoo EM, Ho BK et al. Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry. Int J Tuberc Lung Dis 2015; 19:764–71.
Muñoz-Sellart M, Cuevas LE, Tumato M, et al. Factors associated with poor tuberculosis treatment outcome in the Southern Region of Ethiopia. Int J Tuberc Lung Dis 2010; 14: 973-9.
World Health Organization (WHO). WHO policy on TB/HIV collaborative activities: guidelines for national programmes and other stakeholders. Geneva, 2012.
Lima LM, Harter J, Tomberg JO, Vieirac DA, Antunesd ML, Cardozo-Gonzalese RI. Monitoring and assessment of outcome in cases of tuberculosis in a municipality of Southern Brazil. Rev. Gaúcha Enferm. Vol.37 no.1 Porto Alegre 2016 Epub Mar 01, 2016. doi.org/10.1590/1983-1447.2016....
Van Hest, R, Ködmön, C, Verver, S, et al. Tuberculosis treatment outcome monitoring in European Union countries: systematic review. The European Respiratory Journal 2013; 41:635–43.
Farah MG, Tverdal A, Steen TW, et al. Treatment outcome of new culture positive pulmonary tuberculosis in Norway. BMC Public Health 2005; 5:14.
Faustini A, Hall AJ, Perucci CA. Tuberculosis treatment outcomes in Europe: a systematic review. European Respiratory Journal 2005; 26:503-10. Web. 13 Nov. 2016.
Helbling P, Medinger C, Altpeter E, et al. Outcome of treatment of pulmonary tuberculosis in Switzerland in 1996. Swiss Med Wkly 2002; 132:517–22.
Fernandes A, Miguel JP. Health and migration in European Union: better health for all in an inclusive society. 291173/09. Lisboa. Instituto Nacional de Saude Doutor Ricardo Jorge 2009.
Karim F, Ahmed F, Begum I, et al. Female-male differences at various clinical steps of tuberculosis management in rural Bangladesh. Int J Tuberc Lung Dis 2008; 12:1336-9.
Falzon D, Le Strat Y, Belghiti F, Euro TB. Correspondents. Exploring the determinants of treatment success for tuberculosis cases in Europe.Int J Tuberc Lung Dis 2005; 9:1224-9.
Connolly C, Davies GR, Wilkinson D. Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa. Int J Tuberc Lung Dis 1999; 3:1081-7.
Nhamoyebonde S, Leslie A. Biological differences between the sexes and susceptibility to tuberculosis. J Infect Dis 2014; 209(Suppl 3):S100-6.
Budzik JM, Jarlsberg LG, Higashi J et al. Pyrazinamide resistance, Mycobacterium tuberculosis lineage and treatment outcomes in San Francisco, California. PLoS One 2014;9:e95645.
Espinal MA, Kim SJ, Suarez PG et al. Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA 2000; 283:2537-45.
Seung KJ, Gelmanova IE, Peremitin GG, et al. The effect of initial drug resistance on treatment response and acquired drug resistance during standardized short-course chemotherapy for tuberculosis. Clin Infect Dis 2004;39:1321-8.
Báez-Saldaña R, Delgado-Sánchez G, García-García L, et al. Isoniazid Mono-Resistant Tuberculosis: Impact on Treatment Outcome and Survival of Pulmonary Tuberculosis Patients in Southern Mexico 1995-2010. PLoS One 2016; 11:e0168955.
Villegas L, Otero L, Sterling TR, et al. Prevalence, Risk Factors, and Treatment Outcomes of Isoniazid- and Rifampicin-MonoResistant Pulmonary Tuberculosis in Lima, Peru. PLoS One 2016; 11:e0152933.
Meyssonnier V, Bui TV, Veziris N, et al. Rifampicin mono-resistant tuberculosis in France: a 2005-2010 retrospective cohort analysis. BMC Infect Dis 2014; 14:18.
Babalik A, Kilicaslan Z, Kiziltas S, et al. A retrospective case-control study, factors affecting treatment outcomes for pulmonary tuberculosis in Istanbul, Turkey. Balkan Med J 2013; 30:204-10.
Garrido Mda S, Penna ML, Perez-Porcuna TM, et al. Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study. PLoS One 2012; 7:e39134.
Mi F, Tan S, Liang L, et al. Diabetes mellitus and tuberculosis: pattern of tuberculosis, two-month smear conversion and treatment outcomes in Guangzhou, China. Trop Med Int Health 2013; 18:1379-85.
Deiss RG, Rodwell TC, Garfein RS. Tuberculosis and Drug Use: Review and Update. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 2009; 48:10.1086/594126.
Valin N, Hejblum G, Borget I, et al. Management and treatment outcomes of tuberculous patients, eastern Paris, France, 2004. Int J Tuberc Lung Dis 2009; 13:881-7.
Diel R, Niemann S. Outcome of tuberculosis treatmentin Hamburg: a survey, 1997-2001. Int J Tuberc Lung Dis 2003; 7:124-31.
Working Group on Completion of Tuberculosis Treatment in Spain, Cayla JA, Caminero JA, Rey R, Lara N, Valles X, GaldosTanguis H. Current status of treatment completion and fatality among tuberculosis patients in Spain. Int J Tuberc Lung Dis 2004; 8:458-64.