Epidemiological and clinical features of 139 patients with tuberculosis at a teaching hospital in Italy (Pisa, 1996–2000)

In order to describe epidemiologic and clinical features of patients with tuberculosis (TB) identified recently in the hospital of Pisa (Tuscany, Italy), a retrospective study of all cases of TB notified to the Local Public Health Service during January 1996–December 2000 was performed. The diagnosis of TB was made following the criteria of the WHO. A total of 139 patients affected by TB were identified. Diagnosis was microbiologically proved in 81 patients. Mean age was 53.8 ± 20.5 S.D. yrs. Thirty-five (25.2%) patients were extra European community citizens (mostly from Africa). The incidence of TB (N/100.000) was 8.4 in 1996 and 6.8 in 2000. Sixty-eight point three per cent of patients had pulmonary TB, 24.5% extrapulmonary and 7.2% mixed TB. The rate of extrapulmonary TB was 15.9% and 39.2% in the 1996–98 and in the 1999–2000 periods, respectively (p = 0.002). Extrapulmonary TB was more frequent in extra European community citizens (42.8%) than in Italian ones (18.3%), p = 0.003. Seven patients were presenting also advanced HIV infection. Microscopic examination for acid fast bacilli in sputum or bronchial secretion resulted negative in 17.4% of proved pulmonary TB (positive culture for Mycobacterium tuberculosis). The chest x-rays showed pleural effusion in 19 patients. Pulmonary cavitation was documented in 15 patients with negative chest x-rays. Fever was not present in 42.4% of the patients at the moment of diagnosis. Three point eight percent of the isolated strains of M. tuberculosis were in vitro multidrug-resistant. The data presented showed an important rate of TB in Pisa. We have yet to understand if the decreased rate observed in 2000 represents a new trend as reported in other North American and European countries. The rate of extrapulmonary TB shows a trend to increase accordingly to recent literature. The isolation rate of multidrug-resistant strains of M. tuberculosis in Pisa seems to be similar to the rates reported in other areas of Europe.