Vol.11, No 2, 2004 pp. 74 - 79
UC 616.24-053.6-085
TUBERCULOSIS IN ADOLESCENCE – IDENTIFICATION
AND TREATMENT OF HIGH RISK GROUPS AND HIGH RISK INDIVIDUALS
Milan M. Radović, Ivanka N. Djordjević, Slavica N. Golubović, Grozdana
D. Pejović
Clinic for Pulmonary Diseases and Tuberculosis – Knez Selo, Clinical
Centre Niš, Serbia and Montenegro
Summary. Tuberculosis (TB) in teenagers has recently been an increasing
phenomenon in our clinical practice.
During the study, 37 (3.4%) teenage TB patients (pts) were analyzed
retrospectively, from January l992 – December 2001. Two groups of TB cases
were registered: 15 pts in the period 1992 -1996, when we used only the
old National Tuberculosis Program (NTP) and 22 pts in 1997-2001 when we
used the new NTP by WHO recommendations and DOTS strategy. Generally, 94.6%
were new cases and 5.4% defaulters. By the social status most of the pts
59.5% were students, 40.5% had bad habits (alcohol, drug abuse) with the
village / city ratio of 67.6% / 32.3%. BCG scar hadn't been seen in 27.1%
of the pts, while 86.5% had positive tuberculin skin test. Chronic cough
and weight loss were dominant symptoms (91.9% pts), while parenchyma cavities
were the leading radiological feature (75.8%). Extrapulmonary TB lesions,
mostly on pleura (16.2%) and kidney (5.4%) had been noticed in 32.4% of
the pts. Close contact; smear conversion rate and only the culture positive
pts registered significance (p<0.05). The pts (67.5% of them) were treated
by Isoniasid (H), Rifampicin (R), Pyrazinamide (Z), Streptomycin (S) /
Ethambutol (E), 29.7% H, R, Z and 2.8% H, R, Z, S, E. Most frequent therapy
side effects were liver dysfunction (16.2%), while 10.8% pts had allergy
on Z.
The increasing frequency of TB among teenagers (up to 6% of new cases
annually, due to close contact with defaulters/treatment failures) does
not seem to be a problem (successful conversion rate), but reflects the
need for an effective implementation of NTP.
Key words: Tuberculosis, adolescences, directly observed therapy,
antituberculotics
TUBERKULOZA U ADOLESCENATA –
IDENTIFIKACIJA VISOKO RIZIČNIH GRUPA I POJEDINACA
Kratak sadržaj: Tuberkuloza (TB) u tinejdžera (12-19 godina starosti),
poslednjih godina beleži lagani porast.
Retrospektivnom analizom kliničkih podataka 1090 TB bol koji su tokom
1992.-2001. dijagnostikovani i lečeni u Klinici za plućne bolesti i tuberkulozu,
37 (3,4%) bili su adolescenti. Prvu grupu činilo je 15 bolesnika (1992-1996),
kada je primenjivan stari Nacionalni Program za TB (NTP), i drugu 22 bolesnika
(1997-2001.) kada smo koristili nov NTP po preporukama SZO (WHO) i DOTS
strategiju. Ukupno, 94,6% bolesnika su bili novooboleli slučajevi, a 5,4%
recidivi/hroničari. Bilo je 59,5% studenata, a 40,5% imalo loše navike,
sa odnosom selo / grad - 67,6% / 32,3%. Bez BCG ožiljka je bilo 27,1% bolesnika,
a 86,5% je imalo pozitivan tuberkulinski test. Vodeći simptom u 91,9% je
bio hronični kašalj, dok su radiološki dominirale kavitacije u plućnom
parenhimu (75,8%). Ekstrapulmonalne TB lezije su bile u 32,4% bolesnika,
uglavnom na pleuri (16,2%). Bliski kontakt s obolelim od tb, samo na kulturi
sputum pozitivni bol. i konverzija sputum pozitivnih bol. direktnom mikroskopijom,
pokazivali su značajnost izmedju ispitivanih grupa (p<0,05). 67,5% je
tretirano Isoniasidom (H), Rifampicinom (R), Pyrazinamidom (Z) i Streptomycinom
(S) / Ethambutolom (E), 29,7% H, R, Z / E i 2,8% H, R, Z, S, E. Disfunkciju
jetrenih enzima je imalo 16,2% bolesnika, a 10,8% alergijske manifestacije
na Z.
Povećana incidenca TB u adolescentata - do 6% novootkrivenih slučajeva
godišnje, izgleda ne predstavlja veći epidemiološki problem, obzirom na
uspešnu i brzu konverziju sputuma, ali ukazuje na potrebu efektivnijeg
sprovodjenja NTP.
Ključne reči: Tuberkuloza, adolescencija, direktno kontrolisano
lečenje, antituberkulotici
