Lymph node tuberculosis in patients from regions with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection.

BACKGROUND: Few large cohorts of patients with lymph node tuberculosis (LNTB) have been reported in developed countries. OBJECTIVE: To describe the epidemiological and clinical characteristics of LNTB in patients living in France but born and raised in geographic areas with varying burdens of tuberculosis and human immunodeficiency virus (HIV) infection. DESIGN: A retrospective study of all patients with bacteriologically-proven LNTB assessed in a French hospital from March 1996 through April 2005. RESULTS: The analysis included 92 patients. HIV coinfected patients had a higher risk than those without HIV of presenting with disseminated TB and systemic symptoms and of hospitalization. Lymph node diagnostic procedures had a high yield when samples were cultured. About 25% of patients had an abnormal chest radiograph, and most of them were positive for acid-fast bacilli on sputum smears or for Mycobacterium tuberculosis culture. Treatment was generally prescribed for a longer duration than that recommended by international guidelines. One quarter of the patients developed a paradoxical reaction. A high proportion of our patients were classified as nonadherent and 20% defaulted or were lost to follow-up. CONCLUSION: Most of the differences in the clinical presentation among patients from various geographic areas were driven by the epidemiology of TB and HIV in the countries of origin. LNTB is frequently a clinical sign of disseminated disease, and culture for M. tuberculosis from LN or other sites is crucial for diagnosis. Adopting the strategy of Directly Observed Treatment, Short course (DOTS) might reduce the rates of nonadherence and default.

[Health care channels for new cases of respiratory tuberculosis in Seine Saint-Denis in 1984-1986]. / Les filières de soins des nouveaux cas de tuberculose respiratoire en Seine Saint-Denis en 1984-1986.

The purpose of this study was to observe routine practice in the care of tuberculosis cases treated in the Seine Saint-Denis department in 1984, with reference to the recent recommendations of the French Pneumology Society. The pathway of each patient through the care network was established for 336 adult cases being treated for respiratory tuberculosis for the first time. The social and economic cost of each pathway was evaluated. The results show the multiplicity of health services intervening in the care of these patients, the persistence of hospitalization, sanatorium care, and long sick-leaves from work, together with major differences in the care pathways according to the nationality, sex, and socio-economic group of the patients. The cost of tuberculosis treatment is shown to be high for both patients and the community.