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.
Journal of military pharmaco-medicine no7-2019 EVALUATE THE STATUS OF TUBERCULOSIS DISEASES TREATED AT THE RESPITORARY CENTRE, 103 MILITARY HOSPITAL FROM 2013 TO 2018 Nguyen Chi Tuan1; Mai Xuan Khan1; Nguyen Lam1 Nguyen Thanh Tung1; Dang Thi Ngoc Quynh1 SUMMARY Objectives: To study the situation of diagnosing, admitting and treating tuberculosis patients at the Respiratory Center, 103 Military Hospital in years (2013 - 2018) Method: Retrospective analysis of cases treated at the Respiratory Center, 103 Military Hospital in 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 103 Military Hospital Corresponding author: Nguyen Thanh Tung (hathanhtung103@gmail.com) Date received: 17/05/2019 Date accepted: 23/08/2019 114 Journal of military pharmaco-medicine no7-2019 SUBJECTS AND METHODS 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 Methods - Descriptive, retrospective study 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 - Collect medical records of patients treated at the Respiratory Centre, 103 Military Hospital from 01- 2013 to 10 - 2018 but not have the criteria of having bacteriological evidence - 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 RESULTS AND DISCUSSION * 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, * Data analysis: According to SPSS 20 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 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 115 Journal of military pharmaco-medicine no7-2019 Table 1: Distribution of TB patients according to age and gender Age group Gender Total 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 ≥ 65 Male 238 312 243 225 209 258 1,485 Female 89 106 77 59 76 113 520 327 418 320 284 285 371 2,005 18.5 100 Total % 53.12 28.38 - 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] Characteristics of pulmonary TB Table 2: Classification of pulmonary TB patients according to the National Tuberculosis Control Programme Unknown treatment history n % 31 1,115 69.65 0 486 30.35 73 31 1,601 100 Classification of pulmonary TB New Pulmonary TB patients with bacteriological evidence 1,005 73 Pulmonary TB patients without bacteriological evidence 486 Total 1,491 Relapse Re-treatment Total - 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] 116 Journal of military pharmaco-medicine no7-2019 Table 3: Classification of patients with new AFB smear positive pulmonary TB according to age group Age group Index Total 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 ≥ 65 n 120 154 105 75 193 252 899 % 13.34 17.13 11.68 8.34 21.46 28.05 100 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 Characteristics of extrapulmonary TB Table 4: Classification of extrapulmonary TB patients according tothe National Tuberculosis Control Programme Total Unknown treatment history n % 3 91 72.03 0 113 27.97 3 404 100 Classification of extrapulmonary TB New Extrapulmonary TB patients with histological evidence 279 Extrapulmonary TB patients without histological evidence 113 Total 392 Relapse Re-treatment - 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 117 Journal of military pharmaco-medicine no7-2019 Proportion of drug-resistant TB From January 2018, Xpert MTB/RIF has been began performing at 103 Military 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: 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 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% 118 - 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 The Ministry of Health Guidelines for diagnosis, treatment and prevention of tuberculosis in 2018 pp.22-25 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 10 years (2001 - 2010) Military Medicine and Pharmacy Journal 2012, No 1, pp.115-120 The Ministry of Health The National Tuberculosis Control Programme Activity Summary Report of the TB control Programme in 2017 Hanoi 2017 The Ministry of Health The National Tuberculosis Control Programme Activity Summary Report of the TB control Programme in 2018 Hanoi 2018 WHO Global tuberculosis report 2018 WHO Global tuberculosis report 2017 ... 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. .. diagnosis): Patients diagnosed and treated TB by clinicians - Collect medical records of patients treated at the Respiratory Centre, 103 Military Hospital from 01- 2013 to 10 - 2018 but not have the criteria... When studying the situation of admitting and treating TB patients at the Respiratory Center, 103 Military Hospital for years (2013 - 2018) , we found that: - The total number of TB patients was