Ömer ARAZ, Leyla SAĞLAM, Turgut YAPANOĞLU, Arzu MİRİCİ, Bülent AYDINLI, Hasan KAYNAR, Metin AKGÜN, Kemalettin ÖZDEN

Clinical and social characteristics of the patients with tuberculosis in Eastern Anatolia

Tüberküloz (Tbc) önemli bir halk sağlığı problemi olup, Tbc’ye yol açan risk faktörleri iyi bilinmektedir. Ancak risk faktörleri açısından bölgesel farklılıklar olabilir. Bu çalışmada, bölgemizdeki Tbc hastalarının demografik özelliklerini ve risk faktörlerini belirlemeyi ve olası nedenlerini tartışmayı amaçladık. Çalışmaya, 1997-2004 yılları arasında hastanemizde tanı konulan, ortalama yaşları 38 ± 18 yıl olan, 145’i erkek 108’i kadın olmak üzere toplam 253 hasta (117’si pulmoner, 136’sı ekstrapulmoner) alındı. Demografik ve klinik özellikleri gözden geçirildi. Tbc en sık şehir merkezinde ve özellikle ev hanımlarında görülmekteydi (%38.3). Kırsal alanda ise çiftçilikle uğraşan erkeklerde daha sık görülmekteydi (%19.8). Yine Tbc sıklığı okullarda (öğrenci, öğretmen veya memur) fazla idi (%14.6). İnşaat işçilerinde de diğer iş kollarına göre daha fazla görülmekteydi. Olguların %10.3’ünde geçirilmiş Tbc, %14.2’sinde temas (çoğunlukla aile bireylerinden) ve %17.4’ünde ek hastalık öyküsü vardı. En sık rastlanan ek hastalık, diyabet idi. Sonuç olarak; Tbc şehir merkezlerinde kadınlarda, kırsal alanlarda ise erkeklerde daha sık görülmekteydi. Okullar Tbc gelişimi açısından önemli bir kaynak olarak görülüyordu. Bölgemizde Tbc’nin önlenebilmesi için olguların etkin bir şekilde tedavi edilmesi (doğrudan gözetimli tedavi gibi) ve özellikle koruyucu önlemleri içeren etkin bir kontrol programına gereksinim olduğu görülmektedir.

Doğu Anadolu’daki tüberküloz hastalarının klinik ve sosyal özellikleri

Tuberculosis (TB) is an important public-health problem. The risk factors for TB are well-known. However, there may be some regional differences. In this study, we aimed to investigate the demographic characteristics and regional risk factors for TB and to discuss possible explanations for the difference. The study included totally 253 hospitalized patients (145 male and 108 female, with an average age 38 ± 18) with TB (117 pulmonary and 136 extrapulmonary) between 1997 and 2004. Their demographic and clinical characteristics were reviewed. TB frequency was higher among the non-working females in urban area (38.3%). TB was also common in farmers which are male (19.8%). TB frequency was higher in the school persons including students, the teachers and the school officials (14.6%) and in the building workers compared with the other workers. There were a history of previous TB, TB exposure (mostly from family members) and associated disease in 10.3%, 14.2% and 17.4% of cases, respectively. The most encountered associated disease was diabetes. The results indicate that TB was most common among non-working females and was also increased among the men in rural areas, and schools seem to be an important source of TB transmission. Thus, an effective control program covering the treatment of cases with active disease, such as directly observed treatment, and especially preventive measures should be considered to control the disease transmission in our region.

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1. Kochi A. The global tuberculosis situation and the new control strategy of the World Health Organisation. Tubercle 1991; 72: 1-6.
2. Walford D, Noah N. Emerging infectious diseases-United Kingdom. Emerg Infect Dis 1999; 5: 189-94.
3. Ozkara S, Kılıcaslan Z, Ozturk F ve ark. Tuberculosis in Turkey with Regional Data. Toraks Dergisi 2002; 3: 178-87.
4. Kart L, Akduman D, Altin R, et al. Fourteen-year trend of tuberculosis dynamics in the Northwest of Turkey. Respiration 2003; 70: 468-74.
5. Bloch AB. Screening for tuberculosis and tuberculosis infection in high-risk populations. In: Fishman AP, et al. (eds). Fishman’s Pulmonary Diseases and Disorders. 3rd ed. USA: McGraw-Hill, 1998: 2473-81.
6. Aktogu S, Yorgancioglu A, Cirak K, et al. Clinical spectrum of pulmonary and pleural tuberculosis: A report of 5.480 cases. Eur Respir J 1996; 9: 2031-5.
7. Calpe JL, Chiner E, Marin J, et al. Tuberculosis epidemiology in area 15 of the Spanish autonomous community of Valencia: Evolution from 1987 through 2001. Arch Bronconeumol 2005; 41: 118-24.
8. Tekkel M, Rahu M, Loit HM, Baburin A. Risk factors for pulmonary tuberculosis in Estonia. Int J Tuberc Lung Dis 1994; 12: 71-8.
9. Diez M, Huerta C, Moreno T, et al. Multicentre Project for Tuberculosis Research (MPTR) Study Group. Tuberculosis in Spain: Epidemiological pattern and clinical practice. Int J Tuberc Lung Dis 2002; 6: 295-300.
10. Bonadio M, Carpi A, Gigli C, et al. Epidemiological and clinical features of 139 patients with tuberculosis at a teaching hospital in Italy (Pisa, 1996-2000). Biomed Pharmacother 2005; 59: 127-31.
11. Crampin AC, Glynn JR, Floyd S, et al. Tuberculosis and gender: Exploring the patterns in a case control study in Malawi. Int J Tuberc Lung Dis 2004; 8: 194-203.
12. Bacakoglu F, Basoglu OK, Cok G, et al. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 2001; 68: 595-600.
13. Hussain H, Akhtar S, Nanan D. Prevalence of and risk factors associated with Mycobacterium tuberculosis infection in prisoners, North West Frontier Province, Pakistan. Int J Epidemiol 2003; 32: 794-9.
14. Camarca MM, Krauss MR. Active tuberculosis among U.S. Army personnel, 1980 to 1996. Mil Med 2001; 166: 452-6.
15. Raitio M, Tala E. Tuberculosis among health care workers during three recent decades. Eur Respir J 2000; 15:304-7.
16. Alonso-Echanove J, Granich RM, Laszlo A, et al. Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru. Clin Infect Dis 2001; 33: 589-96.
17. Cuhadaroglu C, Erelel M, Tabak L, Kilicaslan Z. Increased risk of tuberculosis in health care workers: A retrospective survey at a teaching hospital in Istanbul, Turkey. BMC Infect Dis 2002; 2: 1471-2334.
18. Saglam L, Akgun M, Aktas E. Induced sputum and bronchoscopy specimens in the diagnosis of tuberculosis. J Int Med Res 2005; 33: 260-5.
19. Akgun M, Saglam L, Kaynar H, et al. Serum IL-18 levels in tuberculosis: Comparison with pneumonia, lung cancer and healthy controls. Respirology 2005; 10: 295-9.
20. Migliori GB, Raviglione MC, Schaberg T, et al. Tuberculosis management in Europe. Task Force of the European Respiratory Society (ERS), the World Health Organisation (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD) Europe Region. Eur Respir J 1999; 14: 978-92.
21. Jasmer RM, Seaman CB, Gonzalez LC, et al. Tuberculosis treatment outcomes: Directly observed therapy compared with self-administered therapy. Am J Respir Crit Care Med 2004; 170: 561-6.