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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">TO describe the evolution of tuberculosis epidemiology in Area 15 of the Autonomous Community of Valencia&#46;</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Cases of tuberculosis were identified by active case finding in Area 15 from January 1987 through December 2001&#46; Clinical and epidemiological data were extracted from case records and a patient interview&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Four hundred seventy-six diagnosed cases of mycobacterial infection were identified &#40;459 tuberculosis&#44; 16 atypical&#44; and 1 mixed&#41;&#59; 423 tuberculosis patients were residents of Area 15&#46; The mean annual incidence rate was 24&#46;6&#47;100&#8200;000 population&#44; representing a rate decrease of 41&#46;5&#37; from 1990&#46; The most frequent risk factors were smoking &#40;38&#37;&#41;&#44; alcoholism &#40;20&#37;&#41;&#44; human immunodeficiency virus &#40;HIV&#41; infection &#40;18&#37;&#41;&#44; and contact with a tuberculosis patient &#40;14&#37;&#41;&#46; The site of tuberculosis involvement was the lung in 61&#37; &#40;49&#37; bacillus positive&#44; with a nonsignificant trend to decrease over time&#41;&#44; nonpulmonary in 26&#37;&#44; and mixed in 13&#37;&#46; The radiographic pattern observed most often was pulmonary infiltrates &#40;67&#37;&#41;&#44; and lower lobe involvement tended to increase over time&#46; Diagnosis was by acid-fact bacillus stain for 77&#37;&#44; clinical picture for 16&#37;&#44; and histological for 7&#37;&#46; Isoniazid resistance was detected in 1&#46;5&#37; and rifampicin resistance in 0&#46;3&#37;&#46; Patients were hospitalized during diagnosis in 79&#37; of cases&#59; the mean stay was 18 days&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The incidence of tuberculosis has decreased in spite of the HIV pandemic&#46; Risk factors have not changed&#44; bacteriological diagnosis has improved&#44; and the location of pulmonary infiltrates has changed&#46; No influence of immigration on the incidence rate of tuberculosis has been detected to date&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Valorar la evoluci&#243;n de las caracter&#237;sticas epidemiol&#243;gicas de la enfermedad tuberculosa &#40;TB&#41; en el &#193;rea 15 de la Comunidad Valenciana&#46;</p> <span class="elsevierStyleSectionTitle">Material y M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Mediante b&#250;squeda activa se identificaron todos los casos de TB diagnosticados en el &#225;rea des-de enero de 1987 a diciembre de 2001&#46; Se recogi&#243; informaci&#243;n cl&#237;nica y epidemiol&#243;gica de la historia cl&#237;nica y de la entrevista con el paciente&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 476 casos de micobacteriosis &#40;459 TB&#44; 16 at&#237;picas y una mixta&#41;&#44; de los cuales eran residentes en el &#225;rea 423 casos de TB&#46; La tasa media anual fue de 24&#44;6&#47;10<span class="elsevierStyleSup">5</span>&#44; con un descenso del 41&#44;5&#37; desde 1990&#46; Los factores de riesgo m&#225;s frecuentes fueron&#58; tabaquismo en el 38&#37;&#44; etilismo en el 20&#37;&#44; infecci&#243;n por el virus de la inmunodeficiencia humana &#40;VIH&#41; en el 18&#37; y contacto con TB en el 14&#37;&#46; La localizaci&#243;n fue s&#243;lo pulmonar en el 61&#37; de los casos &#40;bacil&#237;feros en el 49&#37;&#44; con tendencia a disminuir&#44; aunque no significativamente&#41;&#44; extrapulmonar en el 26&#37; y mixta en el 13&#37;&#59; los infiltrados &#40;67&#37;&#41; constituyeron el patr&#243;n m&#225;s frecuente&#44; con tendencia al aumento de incidencia en los l&#243;bulos inferiores&#46; El diagn&#243;stico fue bacteriol&#243;gico en el 77&#37; de los pacientes&#44; cl&#237;nico en el 16&#37; e histol&#243;gico en el 7&#37;&#46; Fueron resistentes a isoniacida el 1&#44;5&#37; de los casos y a rifampicina el 0&#44;3&#37;&#46; El 79&#37; ingres&#243; para diagn&#243;stico&#44; con una estancia media de 18 d&#237;as&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La TB ha disminuido su tasa&#44; pese a la pandemia del VIH&#46; No hay cambios en los factores de riesgo&#44; se ha mejorado el diagn&#243;stico bacteriol&#243;gico y hemos observado cambios en la localizaci&#243;n de los infiltrados pulmonares&#46; La inmigraci&#243;n no ha tenido por el momento influencia sobre la tasa de TB&#46;</p>"
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Vol. 41. Issue 3.
Pages 118-124 (March 2005)
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Vol. 41. Issue 3.
Pages 118-124 (March 2005)
Original Articles
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Tuberculosis Epidemiology in Area 15 of the Spanish Autonomous Community of Valencia: Evolution From 1987 Through 2001
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J.L. Calpea, E. Chinerb, J. Marínc, V. Armerod, A. Calpea,
Corresponding author
calpe_jos@gva.es

Correspondence: Dr. J.L. Calpe. Servicio de Neumología. Hospital Marina Baixa. Partida Galandú, 5. 03570 Villajoyosa. Alicante. España
a Servicio de Neumología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
b Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
c Servicio de Neumología, Universidad de Valencia, Valencia, Spain
d Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
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Objectives

TO describe the evolution of tuberculosis epidemiology in Area 15 of the Autonomous Community of Valencia.

Material and Methods

Cases of tuberculosis were identified by active case finding in Area 15 from January 1987 through December 2001. Clinical and epidemiological data were extracted from case records and a patient interview.

Results

Four hundred seventy-six diagnosed cases of mycobacterial infection were identified (459 tuberculosis, 16 atypical, and 1 mixed); 423 tuberculosis patients were residents of Area 15. The mean annual incidence rate was 24.6/100 000 population, representing a rate decrease of 41.5% from 1990. The most frequent risk factors were smoking (38%), alcoholism (20%), human immunodeficiency virus (HIV) infection (18%), and contact with a tuberculosis patient (14%). The site of tuberculosis involvement was the lung in 61% (49% bacillus positive, with a nonsignificant trend to decrease over time), nonpulmonary in 26%, and mixed in 13%. The radiographic pattern observed most often was pulmonary infiltrates (67%), and lower lobe involvement tended to increase over time. Diagnosis was by acid-fact bacillus stain for 77%, clinical picture for 16%, and histological for 7%. Isoniazid resistance was detected in 1.5% and rifampicin resistance in 0.3%. Patients were hospitalized during diagnosis in 79% of cases; the mean stay was 18 days.

Conclusions

The incidence of tuberculosis has decreased in spite of the HIV pandemic. Risk factors have not changed, bacteriological diagnosis has improved, and the location of pulmonary infiltrates has changed. No influence of immigration on the incidence rate of tuberculosis has been detected to date.

Key Words:
Tuberculosis
Epidemiology
Human immunodeficiency virus (HIV)
Evolution
Objetivos

Valorar la evolución de las características epidemiológicas de la enfermedad tuberculosa (TB) en el Área 15 de la Comunidad Valenciana.

Material y Métodos

Mediante búsqueda activa se identificaron todos los casos de TB diagnosticados en el área des-de enero de 1987 a diciembre de 2001. Se recogió información clínica y epidemiológica de la historia clínica y de la entrevista con el paciente.

Resultados

Se diagnosticaron 476 casos de micobacteriosis (459 TB, 16 atípicas y una mixta), de los cuales eran residentes en el área 423 casos de TB. La tasa media anual fue de 24,6/105, con un descenso del 41,5% desde 1990. Los factores de riesgo más frecuentes fueron: tabaquismo en el 38%, etilismo en el 20%, infección por el virus de la inmunodeficiencia humana (VIH) en el 18% y contacto con TB en el 14%. La localización fue sólo pulmonar en el 61% de los casos (bacilíferos en el 49%, con tendencia a disminuir, aunque no significativamente), extrapulmonar en el 26% y mixta en el 13%; los infiltrados (67%) constituyeron el patrón más frecuente, con tendencia al aumento de incidencia en los lóbulos inferiores. El diagnóstico fue bacteriológico en el 77% de los pacientes, clínico en el 16% e histológico en el 7%. Fueron resistentes a isoniacida el 1,5% de los casos y a rifampicina el 0,3%. El 79% ingresó para diagnóstico, con una estancia media de 18 días.

Conclusiones

La TB ha disminuido su tasa, pese a la pandemia del VIH. No hay cambios en los factores de riesgo, se ha mejorado el diagnóstico bacteriológico y hemos observado cambios en la localización de los infiltrados pulmonares. La inmigración no ha tenido por el momento influencia sobre la tasa de TB.

Palabras clave:
Tuberculosis
Epidemiología
Virus de la inmunodeficiencia humana (VIH)
Evolución
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Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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