Arch Hellen Med, 23(1), January-February 2006, 52-62
Epidemiology of pulmonary tuberculosis among patients of two hospitals in Athens
*D. HOUHOULA,1 *N. SKARMOUTSOU,1,2 E. FAVIOU,3 E. FAKIRI,2 S. NIKOLAOU,3 C. VLETSAS,2
OBJECTIVE Despite its profound clinical significance and worldwide resurgence, the epidemiology of pulmonary tuberculosis (TB) among adults in Greece is poorly defined. The goal of this study was to collect relevant epidemiological data from patients diagnosed with TB in the two largest pulmonary hospitals in Athens and to characterize the respective isolates.
METHOD Demographic, clinical and laboratory data were obtained from 250 TB patients hospitalized consecutively in the "Sotiria" and "Sismanoglio" hospitals. Susceptibility of the respective Mycobacterium tuberculosis isolates to five antimycobacterial agents was assessed. All strains originating from "Sotiria" and selected strains from "Sismanoglio" were genotyped by the Mycobacterial Interspersed Repeat Unit (MIRU) method.
RESULTS Most patients were males (75.6%), residents of Attika (76%), and had pulmonary TB (90.8%), a positive PPD test (86.1%) and a positive acid fast smear (73.2%), while 46.8% were of low socioeconomic status and 31.2% were non-Greek-born. Known risk factors for the development of TB were identified: chronic disease 27.6%, immunosuppression 9.6%, substance abuse 11.2% and institutionalization 7.6%, while 11.2% had suffered from TB in the past, half of whom were noncompliant to treatment. Non-Greeks more frequently demonstrated low socioeconomic status (66.7% and 37.8%, respectively, P<0.001) and resided more frequently in Attika (89.7% and 69.8%, respectively, P=0.001). Greeks more often reported chronic disease (36% and 9%, respectively, P<0.001) and immunosuppression (11.1% and 6.4%, respectively, P=0.025) and were older (56.8±18.3 and 34.0±10.3 years, respectively, P<0.001), with a bimodal age distribution, characteristic for ongoing transmission of TB in the community. The highest resistance rates were detected for isoniazid (14.4%) and streptomycin (23.6%). Multiresistant TB was identified among 3.5% of native Greeks and 15% of patients originating from Eastern European countries (P=0.012), and was significantly associated with past TB (P<0.001). A total of 145 genotypes were identified among 147 strains isolated from "Sotiria" and only two were clustered (two strains for each cluster). Genotyping of all strains originating from institutionalized patients revealed a TB outbreak involving seven patients who resided in three institutions for mental disorders.
CONCLUSIONS This report constitutes the first description of the epidemiology of pulmonary TB and the first documentation of an outbreak of TB among adults in Greece.
Key words: Attika, Epidemiology, Genotyping, Resistance, Tuberculosis.