Ender LEVENT, Numan N. EKİM, Melike B. ŞENER

Anti-tüberkülo tedaviye başlamada gecikme

Bu retrospektif araştırmanın amacı, akciğer/plevra tüberkülozu olan hastalarda, semptomların ortaya çıkışından anti-tüberkülo tedaviye başlayıncaya kadar geçen süreyi (hasta gecikmesi ve doktor gecikmesi) ve bu sürede gecikmeye yol açan faktörleri araştırmaktır. Bu amaçla 66 hasta (45 erkek, 21 kadın) çalışmaya alındı. Yaş ortalaması 36.21 ± 14.36 yaş (18-75 yaş arası) idi. Hastaların 34'ü (%51.5) akciğer tüberkülozu, 26'sı (%39.4) tüberküloz plörezi, 5'i (%7.6) akciğer tüberkülozu ve tüberküloz plörezi, 1'i (%1.5) milier tüberküloz idi. Hastaların 32'sine (%48.4) yayma pozitifliği ile, 17'sine (%25.8) histopatolojik bulgularla ve diğer 17 hastaya (%25.8) klinik ve radyolojik bulgularla tanı konmuştu. Hasta gecikmesindeki medyan süre (semptomların ortaya çıkışı-ilk doktora başvurma arasındaki süre) 15 gün, doktor gecikmesindeki medyan süre (ilk doktora başvurma-tedaviye başlama arasındaki süre) 19 gün idi (p> 0.05). Semptomların çıkışından tedavi başlangıcına kadar geçen medyan süre 60 gün (akciğer tüberkülozu olanlarda medyan 64 gün, tüberküloz plörezisi olanlarda medyan 41.5 gün; p< 0.05) saptandı. Doktor gecikmesi, diğer sağlık birimlerinden hastanemize sevk edilenlerde (p< 0.05); nonspesifik tedavi alanlarda (p< 0.00001) ve klinik-radyolojik bulgulara dayalı tüberküloz tanısı alanlarda (p< 0.01) anlamlı olarak daha uzun saptandı. Semptomların çıkışından sonraki ilk bir ay içinde hastaların %77.3'üne; ikinci ayda ise %48.5'ine tedavi başlanmamıştı. Bu çalışmada olduğu gibi; tüberküloz tedavisine başlamadaki gecikme tüm dünyada yaygın bir sorun olup; daha fazla bulaştırıcılığı olan ilerlemiş hastalığa yol açması nedeniyle önemlidir.

Delay in the initiation of anti-tuberculosis treatment

The purpose of this study was to investigate the delay (patient delay and doctor delay) between the onset of symptoms and commencement of treatment for tuberculosis and the factors that due to the delay in patients with pulmonary/pleural tuberculosis. Sixty-six (45 men, 21 women) notified patients with tuberculosis was examined by a retrospective record review. The mean age was 36.21 ± 14.36 years (range: 18-75 years). Thirty-four (51.5%) study patients had pulmonary, 26 (39.4%) patients had pleural, 5 (7.6%) patients pulmonary and pleural and 1 (1.5%) patient had miliary tuberculosis. The diagnosis of tuberculosis was made in 32 (48.4%) patients with a positive sputum/bronchial washing smear, in 17 (25.8%) patients with histopatologic examination and in 17 (25.8%) patients with clinical and radiological findings of tuberculosis. Patient delay was median 15 days and doctor delay was median 19 days (p> 0.05). The duration between the onset of symptoms and commencement of treatment was median 60 days (for pulmonary tuberculosis was median 64 days; for pleural tuberculosis was median 41.5 days; p< 0.05). The doctor delay was longer in patients referred from other source (p< 0.05), in patients received nonspesific treatment (p< 0.00001), in patients the diagnosis of tuberculosis was confirmed by clinical and radiological findings of tuberculosis (p< 0.01) than other patients. Within first month of onset of symptoms, 77.3% patients had not yet commenced treatment and within second month, 48.5% of patients had not yet commenced treatment either. In conclusion; the delay initiation of anti-tuberculosis treatment was an important public health problem in the world, may result increased patient morbidity and in further spread of the disease.

PDF

___

1. Pirkis JE, Speed BR, Yung AP, et al. Time to initiation of anti-tuberculosis treatment. Tuberc Lung Dis 1996; 11: 401-6.
2. Mathur P, Sacks L, Auten G, et at. Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med 1994; 154:306-10,
3. Rieder HL, Kelly GD, Block AB, et al. Tuberculosis diagnosed at death in the United States. Chest 1991; 100: 618-81.
4. Counsell SR, Tan JS, Dittus RS. Unsuspected pulmonary tuberculosis in a community teaching hospital. Arch Intern Med 1989; 149: 1214-8.
5. Katz I, Rosenthal T, Michaeli D. Undiagnosed tuberculosis İn hospitalized patients. Chest 1985; 81: 110-4.
6. Hopewell PC, Bloom BR. Tuberculosis and other mycobacterial diseases. In: Murray JF, Nadel JA (eds). Textbook of Respiratory Medicine. Philadelphia: W.B. Saunders Company, 1994: 1094-160.
7.Gordin FM, Stutkin G, Schecter G, el at. Presumptiue diagnosis and treatment of pulmonary tuberculosis based on radiografic findings. Am Reu Respir Dis 1989; 139: 1090-3.
8. Angtarel X, Saba J, Perronne C, et al. Empiric antituber-culosis treatment: benefits for earlier diagnosis and treatment of tuberculosis. Tuberc Lung Dis 1994; 15: 334-40.
9. Sheldon CD, King K, Cock K, et al.Notification of tuberculosis: how many cases are neuer reported? Thorax 1992; 47: 1015-18.
10. Ekim NN, Akkurt H, Bumin Ç, et al. Tüberküloz tedavi ue takibinde hastane-dispanser koordinasyonu. Gazi Üniu. Tıp Fak. Dergisi 1989; 5(2); 325-33.
11.Beyers N, Gie RP, Schaaf HS, et at. Detay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis. Tuberc Lung Dis 1994; 15; 260-5.