Comparison of the characteristics of Mycobacterium tuberculosis isolates from sputum and lung lesions in chronic tuberculosis patients.

Mycobacterium tuberculosis (Mtb) in sputum originates from lung cavities in tuberculosis (TB) patients. But drug susceptibility testing (DST) of sputum Mtb can not be conducted the same as in the lung because mutagenesis of bacilli may be happening in the lung during treatment and result in the possibility of the presence of heterogeneous drug-resistant subpopulations in the different lung lesions. This could be one of the reasons for low cure rates for multi-drug resistant (MDR)-TB. We studied the resected lungs of nine surgery patients with chronic TB. The isolates isolated from the sputum and different lung lesions of each patient were tested for phenotypic DST and genotyped using restriction fragment length polymorphism (RFLP) typing method. Genetic analysis to resistance to first and second line drugs was also performed. Five of nine patients were MDR-TB and three XDR-TB. DST results for ten anti-TB drugs were in accordance among different lung lesions in eight patients. However, only three of these eight patients showed the concordance of DST with sputum. Even though the isolates were heteroresistant, genotyping them by RFLP showed the clonal population in each individual patient. Six of eight followed-up patients achieved successful cure. In conclusion, the heteroresistance between sputum and lung lesions and a clonal population without mixed infection might provide useful information in establishing treatment regimen and surgery decision for MDR- and XDR-TB.

[Evaluation of integrated health workers training of basic course (author's transl)].

PIP: Integrated training of field workers was initiated in 1978, with a week training course in family planning, maternal and child health, and tuberculosis control. This course provided orientation. In 1979, a 2 week course actually preparing workers for their field activities was inaugurated. Data collected from 182 field workers who attended the course in 1979 are analyzed here. Mean age of workers was 23.6, 3.4 years lower than a 1971 survey revealed. All workers were licensed, while in 1971 39% were without licenses. 32.8% were dissatisfied with their current job (51.8% among maternal and child health workers). Improved pay and working environment is urgently needed. Most workers were satisfied with the 2 week course and responded favorably to the lecturers, although a few wished to have more contact with the training staff. Audiovisual materials were considered adequate but could be improved. Printed materials were generally well accepted. Practice and demonstration sessions were shown to be effective, while case study and field observation were not; improvement is needed in these areas. The trainees were generally enthusiastic about the program and hopeful about their contributions to integration. More time for study and review was urged, and a continuous effort at curriculum development and operational improvement of the training program is needed. (Author's modified)^ieng