Background of study: Tuberculosis in all its clinical presentations has been increasing all over the World, and this increase is closely related to the human immunodeficiency virus (HIV) epidemic. This fact is particularly relevant in Portugal, where tuberculosis has always been a major public health problem, even before the HIV epidemic.
Objective: The authors propose to determine what the clinical and epidemiological aspects of the disease have been over the period 1990 – 2000 in our infectious disease ward.
Design: The authors carried out a retrospective analysis of all the case files of patients admitted to an Infectious Disease Ward with a diagnosis of tuberculosis during the period 1990 – 2000. The data analyzed was: sex; race; type of HIV; site of infection; clinical presentation; method of diagnosis (bacteriology, histology, or presumptive); mycobacterial species; resistance testing; and outcome.
Results: A total of 812 cases of tuberculosis were admitted over the period studied, with 600 male (73,9%) and 212 female patients (26,1%), and the average age was 32 years. 94,2% of the patients were Caucasian. These 812 cases represent over 40% of all the HIV positive patients admitted over the period analyzed. Infection with HIV 1 was predominant (98,7% amongst males and 99,1% amongst females). Pulmonary tuberculosis was diagnosed in a total of 486 males (81%) and 151 females (71,2%), the remaining cases being cases of extra pulmonary tuberculosis. Diagnosis was confirmed either by bacteriology or histology in 75,9% of the cases, with 24,1% of the diagnosis being presumptive. The analysis also revealed that extra pulmonary
tuberculosis seems to be on the increase. Infection with multi drug resistant strains was diagnosed in 134 cases (16,5%), and seems to have stabilized in the last few years.
Conclusion: In our Ward, tuberculosis in all its clinical presentations has been increasing over the last decade, now being over three times as common as it was in 1990, and was the most important opportunistic infection before and after the introduction of HAART. Apart from the increase in the total number of cases diagnosed, we confirmed that the number of cases of extra pulmonary tuberculosis, as well as the number of infections with MDR strains has become increasingly important over the last decade.
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