To study the situation of diagnosing, admitting and treating tuberculosis patients at the Respiratory Center, 103 Military Hospital in 5 years (2013 - 2018). Method: Retrospective analysis of cases treated at the Respiratory Center, 103 Military Hospital in 5 years (2013 - 2018). Results: The total number of tuberculosis patients was 2,005, accounting for 16.33% (2,005/12,279) of the total center admissions. Most new patients had smear positive pulmonary tuberculosis (AFB+) accounting for 44.84% (899/2,005) of cases.
Trang 1
EVALUATE THE STATUS OF TUBERCULOSIS DISEASES
TREATED AT THE RESPITORARY CENTRE,
103 MILITARY HOSPITAL FROM 2013 TO 2018
Nguyen Chi Tuan 1 ; Mai Xuan Khan 1 ; Nguyen Lam 1
Nguyen Thanh Tung 1 ; Dang Thi Ngoc Quynh 1
SUMMARY
Objectives: To study the situation of diagnosing, admitting and treating tuberculosis patients
at the Respiratory Center, 103 Military Hospital in 5 years (2013 - 2018) Method: Retrospective
analysis of cases treated at the Respiratory Center, 103 Military Hospital in 5 years (2013 -
2018) Results: The total number of tuberculosis patients was 2,005, accounting for 16.33%
(2,005/12,279) of the total center admissions Most new patients had smear positive pulmonary
tuberculosis (AFB+) accounting for 44.84% (899/2,005) of cases There were also 486 patients
with AFB smear negative pulmonary tuberculosis (24.23%) Extrapulmonary tuberculosis was
quite common: 404 patients (accounting for 20.15%), 72.03% of whom were diagnosed by
histopathology Importantly, the rate of drug-resistant tuberculosis was found to be 5.2%
Conclusion: In our series, the tuberculosis incidence was still high and the number of new
tuberculosis patients with AFB smear (+) were the highest, followed by AFB smear negative and
extrapulmonary tuberculosis
* Keywords: Tuberculosis; The situation of treatment
INTRODUCTION
According to estimates by the World
Health Organization (WHO), about 1/3 of
the world’s population are infected by
tuberculosis (TB) bacteria with 10 million
new cases of TB each year [5] TB is the
second leading cause of death among
infectious diseases with about 1.3 million
deaths from TB Currently, TB in the
worldwide is tending to decrease with the
incidence falling over a long period of time
and a reduction of 2% per year [5, 6]
Vietnam is currently ranked 16th out of 30
countries with the highest number of TB
patients worldwide and 15th out of 30 countries with the highest multi-drug resistant TB burden globally [5] From
2010 onwards, the number of TB patients treated at the Respiratory Centre, 103 Military Hospital has always increased
The development of modern diagnostic and therapeutic measures as well as changes in the quality of life and living conditions has contributed to change disease structure Therefore, we conducted
this study to: Evaluate the status of TB
disease treated at the Respiratory Centre,
103 Military Hospital from 2013 to 2018
1 103 Military Hospital
Corresponding author: Nguyen Thanh Tung (hathanhtung103@gmail.com)
Date received: 17/05/2019
Date accepted: 23/08/2019
Trang 2
SUBJECTS AND METHODS
1 Subjects
Diagnostic criteria for TB: All the patients
diagnosed with TB (pulmonary TB,
extrapulmonary TB…) according to the
guidelines of the Ministry of Health
and the National Tuberculosis Control
Programme in 2018 [2] had been admitted
and treated at the Respiratory Centre,
103 Military Hospital from 01 - 2013 to
10 - 2018
2 Methods
- Descriptive, retrospective study
- Collect medical records of patients
treated at the Respiratory Centre,
103 Military Hospital from 01- 2013 to
10 - 2018
- Register and analyze the research’s
data according to a unified form
Classification of TB according to the WHO
and the National Tuberculosis Control
Programme in 2018 Determining TB is
based on patients’ hospital discharge
papers
* Classification of TB [2]:
- Classification of TB by anatomical
sites:
+ Pulmonary TB: TB lesions in the lung
parenchyma-bronchi, including military
TB A patient with both pulmonary and
extrapulmonary TB should be classified
as a case of pulmonary TB
+ Extrapulmonary TB: TB lesions in
other organs than the lung, e.g pleura,
lymph nodes, peritoneum, skin, joints and bones, urinary genital tract, meninges, pericardium…
- Classification of TB by bacteriological results:
+ TB patients with bacteriological evidence: patients with at least one of these test results positive: direct sputum smear microscopy, culture, or other TB tests which has been endorsed by the WHO (Xpert MTB/RIF, MGIT)
+ TB patients without bacteriological evidence (clinical diagnosis): Patients diagnosed and treated TB by clinicians but do not have the criteria of having bacteriological evidence
* Data analysis: According to SPSS 20
RESULTS AND DISCUSSION
1 Distribution of TB patients
TB patients: 2,005 (16.33%); non-TB pulmonary disease patients: 10,274 (83.67%)
The average number of TB patients treated annually was 401 This number increased compared to the period of
2001 - 2010 (401 versus 287), but the overall rate decreased (16.33% versus 24.22%) [3], because the number of patients admitted to our center annually increased nearly 3 times compared to each year in the period of 2001 - 2010; as well as TB outpatients under the National Tuberculosis Control Programme has been increasing
Trang 3
Table 1: Distribution of TB patients according to age and gender
Age group Gender
- TB patients were most at the age group of 15 to 44 years old (52.12%), the 45 - 64
group ranked the 2nd (28.38%) and the least was the age group ≥ 65 years old (18.5%)
- Male TB patients accounted for a high proportion, the male to female ratio was
2.8/1 This national ratio was 2.5/1 [1]
- This result was consistent with previous studies because men have more risk
factors for respiratory diseases in general and TB in particular than women (eg tobacco addiction, alcoholism ) and TB occurs more frequently in patients under
45 years old and over 65 years old [1, 4]
2 Characteristics of pulmonary TB
Table 2: Classification of pulmonary TB patients according to the National Tuberculosis
Control Programme
Total Classification of
Unknown treatment
Pulmonary TB patients with
Pulmonary TB patients without
- 1,115 pulmonary TB patients (69.65%) had got bacteriological evidence This
proportion was higher than that in the period of 2001 - 2010 (48.45%) due to the
development of new diagnostic techniques, especially molecular biological techniques
(PCR, GeneXpert…) [3] This proportion was also consistent with the national
proportion of pulmonary TB patients with bacteriological evidence in 2018 (73%) [1]
- There were 486 patients with AFB smear negative pulmonary TB, accounting for
30.35% of pulmonary TB patients and 24.23% of TB patients This proportion was
consistent with the national report in 2018 (24.39%) and tends to increase in recent
years [1, 4]
Trang 4
Table 3: Classification of patients with new AFB smear positive pulmonary TB
according to age group
Age group Index
Total
The number of new AFB smear positive pulmonary TB patients was 899, accounting
for 44.84% (899/2,005) of total patients This result was lower than the national
proportion (48.61%) [1] This was the highest proportion group and was the main
source of TB transmission in community, of which the majority were under 45 years old
(42.15%) and over 65 years old (28.05%) Strict management, monitoring and
evaluation need to be conducted for new AFB smear positive pulmonary TB patients
3 Characteristics of extrapulmonary TB
Table 4: Classification of extrapulmonary TB patients according tothe National
Tuberculosis Control Programme
Total Classification of
Unknown treatment
Extrapulmonary TB patients with
- Extrapulmonary TB patients: 404/2,005 (20.15%); this proportion was similar to the
national rate (19.85%) [1]
- 291/404 extrapulmonary TB patients (72.03%) were diagnosed by histopathology,
mainly pleural effusion, lymph node, bone and joint TB…
- This result was consistent with epidemiological studies of pleural diseases in our
country: TB pleural effusion was the most common disease among pleural diseases
[1] The proportion of extrapulmonary TB patients was higher than that in the period
of 2001 - 2010 (5.46%) [3] due to the development of diagnosis techniques (pleural biopsy, lymph node biopsy, thoracoscopy…), so the ability of definitive
diagnosis is higher
Trang 5
4 Proportion of drug-resistant TB
From January 2018, Xpert MTB/RIF has
Hospital There were 96 GeneXpert
positive patients in their sputum or bronchial
washings, including:
- GeneXpert positive without rifampicin
resistance: 91 patients (14.8%)
- GeneXpert positive with rifampicin
resistance: 5 patients (accounting for 5.2%),
all of these cases were TB relapse or
default
This proportion was also consistent with
the national rate of drug-resistant TB
(4 - 6%) [1]
CONCLUSION
When studying the situation of
admitting and treating TB patients at the
Respiratory Center, 103 Military Hospital
for 5 years (2013 - 2018), we found that:
- The total number of TB patients was
2,005, accounting for 16.33% of all the
patients, most of whom were under 45
years old (53.12%) and the least was the
age group ≥ 65 years old (18.5%)
- The number of new AFB smear
positive TB patients was 899, accounting
for 44.84%
- The number of new AFB smear negative TB patients was 486, accounting for 24.23%
- Extrapulmonary TB patients: 404 accounting for 20.15%, of which, 72.03% were diagnosed by histopathology, mainly pleural effusion, lymph node, joint and bone TB
- The percentage of TB drug-resistance was 5.2%
REFERENCES
1 The Ministry of Health Guidelines for
diagnosis, treatment and prevention of tuberculosis in 2018 pp.22-25
2 Nguyen Huy Luc, Do Quyet, Ta Ba
Thang, Dao Ngoc Bang Respiratory diseases
structure at the Department of Tuberculosis & Pulmonary Diseases, 103 Military Hospital for
Pharmacy Journal 2012, No 1, pp.115-120
3 The Ministry of Health The National
Tuberculosis Control Programme Activity Summary Report of the TB control Programme
in 2017 Hanoi 2017
4 The Ministry of Health The National
Tuberculosis Control Programme Activity Summary Report of the TB control Programme
in 2018 Hanoi 2018
5 WHO Global tuberculosis report 2018
6 WHO Global tuberculosis report 2017.