Search Results (19)

Wstęp: W kilku ostatnich dekadach obserwuje się wzrost izolacji prątków niegruźliczych (NTM, nontuberculous mycobacteria), zwłaszcza w krajach rozwiniętych. Celem pracy była analiza wszystkich gatunków prątków niegruźliczych izolowanych z materiałów biologicznych od pacjentów w Polsce, w latach 2013–2017. Materiał i metody: Badaniem objęto 2799 izolatów, pochodzących głównie z układu oddechowego, które oceniano w referencyjnym laboratorium Instytutu Gruźlicy i Chorób Płuc w Warszawie oraz w Wielopolskim Centrum Pulmonologii i Chirurgii Klatki Piersiowej. Wyniki: W badanym okresie izolowano 35 różnych gatunków NTM. Liczba izolatów wzrosła prawie 1,6-krotnie: od 420 w 2013 roku do 674 w 2017 roku. Najczęściej występowały: M. kansasii, M. avium, M. xenopi, M. gordonae i M. intracellulare. Dominacja tych gatunków NTM w prawie niezmienionej kolejności utrzymywała się przez cały okres. Natomiast przy rozpatrywaniu MAC (M. avium complex) jako całości—od 2015 roku kompleks ten dominował nad M. kansasii. M. avium i M. intracellulare częściej izolowano od kobiet, podczas gdy M. gordonae i M. xenopi od mężczyzn. Nie stwierdzono różnic w częstości występowania NTM u mężczyzn i kobiet. Wśród pacjentów po 65. roku życia dominowały kobiety, zaś u tych pomiędzy 25. a 64. rokiem życia—mężczyźni. Wnioski: W Polsce, podobnie jak w innych krajach, zwiększa się częstość izolacji NTM. Najczęściej izolowanymi gatunkami były: M. kansasii i M. avium. Prątki niegruźlicze występowały u kobiet i mężczyzn z podobną częstością. Full article

Introduction: During the last decades the prevalence of NTM infections has increased, especially in developed countries. The aim of the study was to provide an overview on all NTM isolated from clinical samples in Poland between 2013 and 2017. Material and methods: The study comprised 2799 clinical specimens, mostly respiratory accessed in the reference laboratory of National Tuberculosis and Lung Diseases Research Institute in Warsaw and in the Wielkopolska Center of Pulmonology and Thoracic Surgery, Poland, 2013–2017. Results: During the study period 35 species of NTM were isolated. The number of isolates increased almost 1.6-fold: from 420 in 2013 to 674 in 2017. M. kansasii, M. avium, M. xenopi, M. gordonae and M. intracellulare were the most common species. This NTM pattern was rather stable over the time. If the aggregated amount of all MAC species was taken into account they dominated over M. kansasii from 2015. M. avium and M. intracellulare were more often isolated from women, while M. kansasii, M. gordonae and M. xenopi predominated in men. Men and women were infected almost with the same frequency. In older patients 65+ women were in majority, quite opposite to those aged 25 to 64 years. Conclusion: In Poland, like in other countries increased frequency of isolated NTM. M. kansasii and M. avium were the most frequently identified species from clinical samples. Men and women were infected with NTM with the same frequency. Full article

Od drugiej połowy XX wieku obserwuje się w Polsce systematyczny spadek liczby zachorowań na gruźlicę. Mimo to aktualne wskaźniki epidemiologiczne uzasadniają kontynuację powszechnych szczepień BCG w naszym kraju w najbliższych latach. Poza ochroną przed ciężkimi, krwiopochodnymi postaciami gruźlicy, szczepienie to zmniejsza ryzyko zakażenia prątkiem gruźlicy. Przeciwwskazania do szczepienia BCG to między innymi pierwotne i nabyte niedobory odporności, w tym zaburzenia immunologiczne związane ze stosowanym leczeniem. Do najczęstszych niepożądanych odczynów po szczepieniu BCG należą zmiany w miejscu szczepienia i zmiany odczynowe w lokalnych węzłach chłonnych, zazwyczaj niewymagające leczenia. Metody zapobiegania gruźlicy, szczególnie zalecane w krajach o niskiej zapadalności na tę chorobę, to: diagnostyka osób stykających się z chorym na gruźlicę płuc oraz aktywne wykrywanie i leczenie utajonego zakażenia prątkiem gruźlicy. Utajone zakażenie prątkiem gruźlicy rozpoznaje się na podstawie dodatnich wyników odczynu tuberkulinowego (OT) lub testu wydzielania interferonu gamma, po wykluczeniu gruźlicy aktywnej. Stan ten wymaga leczenia profilaktycznego. Full article

Since the second half of the 20th century the incidence of tuberculosis has been declining in Poland. Despite this, current epidemiological data still support the need for the continued mass BCG vaccination in Poland in the near future. Apart from the protection against severe hematogenous forms of tuberculosis, vaccination lowers the risk of infection with Mycobacterium tuberculosis. Primary and acquired immunodeficiency, including immunity disorders associated with an ongoing treatment, are contraindications to BCG vaccination. The most common adverse effects following BCG vaccination are reactions at the site of injection and in regional lymph nodes, which usually does not require treatment. Methods of tuberculosis prevention, particularly recommended in low-incidence countries, include: diagnostic investigations of patients who had contacts with pulmonary tuberculosis as well as an active detection and treatment of latent Mycobacterium tuberculosis infection. Latent tuberculosis infection can be identified on the basis of positive results of the tuberculin skin test or interferon-gamma release assays after the active disease has been ruled out. This condition does require prophylactic treatment. Full article

Wstęp: Incydenty gruźlicy pozapłucnej stanowią mniej niż 6% wszystkich przypadków gruźlicy w Polsce, choć w innych krajach (zwłaszcza europejskich) ten odsetek jest znacznie wyższy. Celem pracy była ocena kliniczna i epidemiologiczna chorych hospitalizowanych na jednym z oddziałów laryngologicznych w Polsce w czasie 36 lat. Materiał i metody: Badaniem retrospektywnym objęto 71 chorych, których podzielono na trzy grupy w zależności od okresu badania: I—lata 1978–1989 (30 osób, 42%), II—lata 1990–2001 (19 osób, 27%) i III—lata 2002–2013 (22 osoby, 31% wszystkich przypadków). W każdym przypadku podejrzenie gruźlicy stawiano na podstawie wyniku badania histopatologicznego. Wyniki: Najczęściej stwierdzono gruźlicę krtani (54.9%), następnie gruźlicę węzłów chłonnych szyi (29.6%) i ucha (8.5%). W gruźlicy krtani, zmiany najczęściej dotyczyły piętra głośni (76.9%). Chorzy z gruźlicą krtani to w większości mężczyźni (87.2%), średnio 10 lat starsi niż kobiety w każdym z wyróżnionych okresów. Odwrotnie, w gruźlicy węzłów chłonnych szyi, kobiety stanowiły 66,7% przypadków i były średnio dwukrotnie starsze niż mężczyźni (64.0 v. 34.7 roku). Potwierdzenie bakteriologiczne uzyskano tylko u jednego chorego. Wnioski: Liczba chorych diagnozowanych w naszym ośrodku z powodu gruźlicy pozapłucnej w obrębie głowy i szyi była większa w pierwszym 12-letnim okresie, a przez ostatnie 24 lata była stała, podobnie jak najczęstsze umiejscowienia gruźlicy (krtań i węzły chłonne szyi). U chorych z gruźlicą głowy i szyi poza oceną histopatologiczną konieczna jest ocena bakteriologiczna. Full article

Introduction: Extrapulmonary tuberculosis (EPTB) accounts for less than 6% of all tuberculosis (TB) cases in Poland, although in other countries (European in particular) this proportion is much higher. The study was undertaken to evaluate the clinical and epidemiological differences in patients hospitalized in one of Otolaryngology Departments in Poland during 36 years. Material and methods: In a retrospective study, 71 patients were identified and divided into three groups according to the study period: I—1978−1989 (30 patients, 42%), II—1990−2001 (19 patients, 27%) and III—2002−2013 (22 patients, 31% of all cases). In each case histological examination of biopsy specimens was available. Results: Larynx TB (54.9%) was most common, followed by cervical lymph nodes TB (29.6%) and auris TB (8.5%). In laryngeal TB, glottic region was most often affected (76.9%). Patients with larynx TB were mainly men (87.2%), 10 years older than women in each study period. However, in lymph nodes TB group, women constituted 66.7% of cases and were twice as old as men (64.0 vs. 34.7 yrs). Bacteriological confirmation was made in only one patient. Conclusions: The number of patients diagnosed in our center declined in the first period of 12 years and remained stable over the last 24 years, as were the common sites of head and neck EPTB (larynx and cervical lymph nodes). In patients with head and neck TB the biopsy specimens should be examined not only histologically but also for the presence of Mycobacterium tuberculosis. Full article

The authors present the review of factors influencing epidemiological situation of tuberculosis in Poland and in the world. The groups of increased risk of tuberculosis, and clinical conditions predisposing to activation of latent tuberculosis infection (LTBI) such as HIV, uremia, diabetes mellitus, transplantation of organs, treatment with glucocorticosteroids and with antibodies to TNF and to its receptors, were presented. The higher prevalence and worse prognosis of tuberculosis in elderly people was emphasised. The methods of LTBI recognition, according to recent recommendations, with special consideration to patients in immunosupression, were shown. Methods of treatment to prevent LTBI activation, according to WHO experts, were also presented. All data were discussed in relation to the actual epidemiological situation of tuberculosis in Poland. Full article

The authors present the review of factors influencing epidemiological situation of tuberculosis in Poland and in the world. The groups of increased risk of tuberculosis, and clinical conditions predisposing to activation of latent tuberculosis infection (LTBI) such as HIV, uremia, diabetes mellitus, transplantation of organs, treatment with glucocorticosteroids and with antibodies to TNF and to its receptors, were presented. The higher prevalence and worse prognosis of tuberculosis in elderly people was emphasised. The methods of LTBI recognition, according to recent recommendations, with special consideration to patients in immunosupression, were shown. Methods of treatment to prevent LTBI activation, according to WHO experts, were also presented. All data were discussed in relation to the actual epidemiological situation of tuberculosis in Poland. Full article

Introduction: The different epidemiological situation of tuberculosis in various regions of Poland (higher and lower notification rates) was described previously by our group. The patients diagnosed with tuberculosis in the higher notification rate areas were younger and there were more cases of primary tuberculosis (tuberculous pleurisy and tuberculosis of chest lymph nodes) than in the patients diagnosed in the lower notification areas. The aim of the present study was to assess the possible causes of the different epidemiological situation of tuberculosis in various regions of Poland. Material and Methods: Analysis was done at the same regions as in the previous paper. A comparison was made between two groups: Group I, which included three voivodeships with higher rates of notification, from 23.7 to 32.3/100,000 (mean rates in the analysed period of time); and Group II, which included five voivodeships with lower notification rates (mean rates from 12.2 to 18.6/100,000). The wealth of the regions (GDP, gross domestic product per capita), the level of unemployment, and social status of the patients were analysed. We compared the population density in both regions. The results of treatment in both regions were also analysed. Results: We did not find any differences in GDP and unemployment rates between the compared regions. The results of treatment were different in particular regions, but there was no clear tendency for worse results in voivodeships in Group I compared to voivodeships in Group II. However, the number of patients lost from observation was significantly higher in the regions from Group I than in those from Group II. There was also a significantly higher death rate from tuberculosis in younger patients (£ 59 years) from Group I than from Group II. This is additional proof that the epidemiological situation in the two regions was different. Finally, we found that the mean density of population in the regions from Group I was higher than that from Group II. The density of population may influence transmission of tuberculosis. There is also the possibility that the differences in the epidemiological situation in various regions of Poland are caused by historical events. In the past the epidemiological situation of tuberculosis was much worse in the east of Europe than in the west. Just after the Second World War, according to the changes of the Polish territory, many Polish citizens (mainly ancestors of those from Group I) were displaced from the east to the west. Conclusions: In conclusion, the greater number of patients lost from observation, together with the higher density of population in the regions from Group I in comparison with those from Group II, seems to be partly responsible for the difference in the epidemiological situation in the two regions. It is also possible that some patients from Group I are more susceptible to infection and disease caused by Mycobacterium tuberculosis due to their ancestors, who lived in the east of Europe. Full article

Introduction: In 2012 the incidence rate of tuberculosis in Poland was 19.6/100,000 but these was great variability between regions concerning notification rates (from 10.9/100,000 to 30.2/100,000). The aim of the study was to assess whether there are elements that might confirm that these differences are true. To answer this question, we compared the population of TB patients from regions with higher notification rates to the population of patients from regions with lower notifications rates. The data collected during three consecutive years were analysed. We selected for comparison the regions with the lowest and highest notification rates and those in which the notification rates for 3 years (2010–2012) were relatively stable. Material and Methods: Eight regions were chosen: three regions (Group I) with high notification rates (from 23.7 to 32.3/100,000—mean rates in the analysed period of time) and five (Group II) with low notification rates (mean rates from 12.2 to 18.6/100,000). Results: It was found that the proportion of sputum culture-positive patients was significantly higher in Group II. Thus, the difference in the notification rate of cases with culture-confirmed tuberculosis was smaller than the difference in the whole notification rate. Nevertheless, it was still significant. Tubercle bacilli in patients from Group I were significantly more often resistant to one drug. The incidence of chronic fibro-cavernous disease and of tuberculous pneumonia was significantly higher in Group I. The proportion of patients with symptoms was higher in Group I than in Group II. In addition, patients in Group I had the so-called primary tuberculosis (tuberculous pleuritis and tuberculous lymphadenopathy in the chest) significantly more often. It was also found that among patients from Group I there were significantly more children, more (though not significantly) youngsters and significantly fewer elderly patients. Conclusions: Based on these observations, it was concluded that there is a real difference in the epidemiological situation of tuberculosis in the selected regions of Poland with high and low rates of notification. Possible causes of this situation will be presented in a following publication. Full article

Diagnozowanie gruźlicy oparte na bakteryjnym czynniku etiologicznym ma już ponad 100-letnią historię. Nowoczesna terapia rozpoczęła się jednak dopiero po II wojnie światowej wraz z odkryciem i wprowadzeniem do terapii leków przeciwprątkowych. Przez dziesięciolecia grupy międzynarodowych specjalistów pracowały nad ustaleniem najskuteczniejszych schematów leczenia [...] Full article

Introduction: The incidence of tuberculosis in Poland decreased from 128.5 in 100,000 in 1970 to 19.1 in 100,000 in 2010. In many countries, but not in Poland, according to the improvement of the epidemiological situation of tuberculosis (TB), the proportion of the extrapulmonary form of this disease is increasing. The aim of this study was to describe changes in extrapulmonary TB epidemiology in Poland from 1974 to 2010. Material and methods: Retrospective analysis of data from National TB Register on tuberculosis in Poland in the years 1974–2010. The percentage of extrapulmonary tuberculosis among all cases of tuberculosis, the differences in the proportion of extrapulmonary tuberculosis, and differences in various locations of lesions in this form of disease in relation to sex and age groups were assessed. Information was collected from about 626,093 cases of tuberculosis reported to the Register during the period 1972–2010. In 62,251 cases extrapulmonary tuberculosis was the only form of the disease (9.9% of all tuberculosis cases). The study material consisted of 396,344 male and 196,184 female cases; 30,885 subjects were 0–19 years of age, 191,542 were 20–39 years old, 237,256 were 40–59 years old, and 166,410 subjects were ≥ 60 years old. We compared data from the years 1974–1982 with more recent data (2002–2010). The test of proportions for two independent samples was used to assess the significance of differences in proportions. Results: The proportion of extrapulmonary tuberculosis (EPTB) among all TB cases was 11.2% in the years 1974–1982 and only 8.2% in the years 2002–2010. This difference was significant. The proportion of EPTB among all TB cases was higher in women than in men and was higher in people aged 0–19 years than in other age groups. The location of extrapulmonary tuberculosis was different in women and in men. Pleural TB was the most common form of extrapulmonary tuberculosis in both sexes with a predominance of males. Peripheral lymph nodes, bones and joints, urinary, genital, and skin TB were more common in women (these differences were significant). In the youngest age group intrathoracic lymph node TB dominated, and in the older age groups it was pleural TB. In accordance with the increase in age, the proportion of urinary tract, peripheral node, and pericardium TB increased. Central nervous system TB showed no predilection for a particular age group. Conclusions: The proportion of EPTB to all cases of TB is lower in Poland than in other countries. In addition, the proportion of EPTB had significantly decreased from 1974–1982 to 2002–2010. It may be due to difficulties in diagnosis of those forms of TB in Poland. Alternatively it is possible that those cases diagnosed in non-respiratory centres are not reported to the National TB Register. Full article

Przewlekła obturacyjna choroba płuc (POChP) jest trzecią lub czwartą przyczyną zgonu na świecie po nowotworach, chorobach serca i naczyń oraz (w niektórych krajach) śmierci z przyczyn gwałtownych. Wszelkie aspekty choroby od jej patogenezy do paliatywnej opieki pod koniec życia są przedmiotem badań bardzo licznych zespołów naukowców [...] Full article

Introduction: Over 8000 cases of tuberculosis (TB) are diagnosed annually in Poland. People infected with Mycobacterium tuberculosis (MTB) have a risk of active disease of around 10% during their whole life, and the risk is highest in the first two years after infection. Recognizing infection before TB disease development enables prophylaxis against its activation and ceases transmission of infection. Knowledge about the proportion of infected people in the population is crucial to predict the number of new cases of active disease. Materials and methods: The prevalence of latent TB infection (LTBI) was tested in 700 healthy adult inhabitants of the Mazowieckie province in different age groups, using both tuberculin skin test (TST) and interferon gamma release assay (IGRA). Commercial test QuantiFERON^®-TB-Gold In Tube (QFT) was used. All participants were mandatorily BCG vaccinated according to the Polish vaccination schedule. Results: Twenty-three per cent of participants tested positively for QFT, which was significantly less than for TST (50.3%). The prevalence of positive QFT results increased with age, as well as the incidence of TB in Poland. Positive QFT was most frequent in the oldest age group (48.8%) and rarest in the youngest (7.1%). Conversely, positive TST occurred more often in younger participants (45%), who rarely suffer from TB. Among people over 60, with the highest TB incidence rate, only 33.8% tested positively with TST. Concordance between both tests was low, with a kappa value of 0.198. The prevalence of LTBI defined as positive QFT among health care workers (HCW) was significantly higher than among other participants (32.2% v. 20.4%, p < 0.01). Conclusions: LTBI was diagnosed in 23.3% of the tested population of the Mazowieckie province. QFT is a better tool for diagnosing LTBI as it shows a positive correlation with age (as the incidence of TB disease does). Concordance between both tests is low. The prevalence of LTBI in HCW is higher than in other participants.
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