SETTING: Norwegian patients with pulmonary tuberculosis notified to the National Tuberculosis Register in 1975, 1985 and 1995. OBJECTIVE: To assess the proportion of cases attributable to endogenous reactivation, exogenous re-infection and primary infection. DESIGN: We reviewed patients notified with sputum smear and/or culture confirmed pulmonary tuberculosis in 1975 (50% random sample, 95 cases), 1985 (133 cases) and 1995 (70 cases). Information on previous chest X-ray, tuberculin and BCG status was collected from mass screening data files. Strains from 54 patients in 1995 were analysed by IS6110 restriction fragment length polymorphism (RFLP) typing and compared with culture-positive patients notified between 1994 and 1997. RESULTS: Most patients had previously had tuberculosis (65% in 1975, 53% in 1985 and 61% in 1995), either notified with tuberculosis or with X-ray findings indicating previous tuberculosis. Another 10% had a prior infection, but normal X-rays. No previous tuberculosis infection or disease was found in 10% in 1975, 19% in 1985, and 16% in 1995. Of 54 patients with RFLP results, three were caused by laboratory contamination. Of the remaining 51, eight (16%) belonged to a cluster. Among 45 patients with results of both RFLP typing and mass screening, 37 (82.2%) were probably caused by reactivation, six (13.3%) by re-infection and two (4.4%) by primary infection. CONCLUSION: Pulmonary tuberculosis in Norwegian patients can mainly be attributed to reactivation, predominantly in persons with previous changes on chest X-ray.
SETTING: Norwegian patients with pulmonary tuberculosis notified to the National Tuberculosis Register in 1975, 1985 and 1995. OBJECTIVE: To assess the proportion of cases attributable to endogenous reactivation, exogenous re-infection and primary infection. DESIGN: We reviewed patients notified with sputum smear and/or culture confirmed pulmonary tuberculosis in 1975 (50% random sample, 95 cases), 1985 (133 cases) and 1995 (70 cases). Information on previous chest X-ray, tuberculin and BCG status was collected from mass screening data files. Strains from 54 patients in 1995 were analysed by IS6110 restriction fragment length polymorphism (RFLP) typing and compared with culture-positive patients notified between 1994 and 1997. RESULTS: Most patients had previously had tuberculosis (65% in 1975, 53% in 1985 and 61% in 1995), either notified with tuberculosis or with X-ray findings indicating previous tuberculosis. Another 10% had a prior infection, but normal X-rays. No previous tuberculosis infection or disease was found in 10% in 1975, 19% in 1985, and 16% in 1995. Of 54 patients with RFLP results, three were caused by laboratory contamination. Of the remaining 51, eight (16%) belonged to a cluster. Among 45 patients with results of both RFLP typing and mass screening, 37 (82.2%) were probably caused by reactivation, six (13.3%) by re-infection and two (4.4%) by primary infection. CONCLUSION:Pulmonary tuberculosis in Norwegian patients can mainly be attributed to reactivation, predominantly in persons with previous changes on chest X-ray.
Authors: Knut Lönnroth; Giovanni Battista Migliori; Ibrahim Abubakar; Lia D'Ambrosio; Gerard de Vries; Roland Diel; Paul Douglas; Dennis Falzon; Marc-Andre Gaudreau; Delia Goletti; Edilberto R González Ochoa; Philip LoBue; Alberto Matteelli; Howard Njoo; Ivan Solovic; Alistair Story; Tamara Tayeb; Marieke J van der Werf; Diana Weil; Jean-Pierre Zellweger; Mohamed Abdel Aziz; Mohamed R M Al Lawati; Stefano Aliberti; Wouter Arrazola de Oñate; Draurio Barreira; Vineet Bhatia; Francesco Blasi; Amy Bloom; Judith Bruchfeld; Francesco Castelli; Rosella Centis; Daniel Chemtob; Daniela M Cirillo; Alberto Colorado; Andrei Dadu; Ulf R Dahle; Laura De Paoli; Hannah M Dias; Raquel Duarte; Lanfranco Fattorini; Mina Gaga; Haileyesus Getahun; Philippe Glaziou; Lasha Goguadze; Mirtha Del Granado; Walter Haas; Asko Järvinen; Geun-Yong Kwon; Davide Mosca; Payam Nahid; Nobuyuki Nishikiori; Isabel Noguer; Joan O'Donnell; Analita Pace-Asciak; Maria G Pompa; Gilda G Popescu; Carlos Robalo Cordeiro; Karin Rønning; Morten Ruhwald; Jean-Paul Sculier; Aleksandar Simunović; Alison Smith-Palmer; Giovanni Sotgiu; Giorgia Sulis; Carlos A Torres-Duque; Kazunori Umeki; Mukund Uplekar; Catharina van Weezenbeek; Tuula Vasankari; Robert J Vitillo; Constantia Voniatis; Maryse Wanlin; Mario C Raviglione Journal: Eur Respir J Date: 2015-04 Impact factor: 16.671