Screening for tuberculosis in asylum seekers: comparison of chest radiography with an interview-based system.

SETTING: Mandatory initial screening of asylum seekers for tuberculosis (TB) in Switzerland, 2004-2005 and 2007-2008. OBJECTIVE: To compare the yield of screening by chest radiography with an individual assessment based on geographic origin, personal history and symptoms. DESIGN: Cross-sectional retrospective comparison of two 2-year periods. RESULTS: The prevalence of detected TB cases was defined as the proportion of screenees starting anti-tuberculosis treatment for culture-confirmed pulmonary TB within 90 days. TB prevalence was 14.3 per 10,000 asylum seekers screened (31/21,727) using chest radiography and 12.4 (29/23,402) using individual assessment. The sensitivity of radiography was 100% vs. 55% for individual assessment, but its specificity was lower (89.9% vs. 96.0%, respectively). The higher sensitivity of radiography meant shorter delays between screening and start of treatment (median 6 vs. 25 days). Its lower specificity led to a larger proportion of screenees needing further investigations for suspicion of TB (12% vs. 4%). CONCLUSION: The interview-based system initially missed more cases, but the ultimate 90-day yield was comparable for the two periods. The main difference is the delay until start of treatment, which potentially increases transmission and secondary cases. The radiograph system was more burdensome to both the health care system and the screenees, as more suspects required further investigations.

[Lyme borreliosis: significance of the serological diagnosis of an infection with Borrelia burgdorferi in neurological diseases with inflammatory cerebrospinal fluid syndrome]. / Lyme-Borreliose: Bedeutung des serologischen Nachweises einer Infektion mit Borrelia burgdorferi bei neurologischen Erkrankungen mit entzündlichem Liquorsyndrom.

To look for a correlation between positive antibody-response against Borrelia burgdorferi (Bb) and an inflammatory CSF-syndrome, from May 1988 to May 1989 333 patients from the Neurological Department of the University of Bern underwent lumbar puncture with cell count, quantitative and qualitative protein analysis and antibody determination against Bb in serum and CSF. 6 patients with active syphilis were excluded. The results of the 333 remaining patients were analyzed using chi 2 or Fisher's exact test. The antibody determination was performed using an immunoperoxidase assay (IPA). Our results are calculated for three cut-off points: Bb-IgG 1:64, 1:128, 1:256 and/or Bb-IgM 1:16, 1:32, 1:64. We found 11.7% patients to be seropositive (Bb-IgG 1: greater than or equal to 256 and/or Bb-IgM 1: greater than or equal to 64). We demonstrated the following correlations: elevated cell count (greater than 10/mm3 cells CSF) versus elevated Bb-titer (1: greater than or equal to 256), elevated total protein of CSF (greater than 48 mg%) versus elevated Bb-titer, blood-brain-barrier dysfunction versus elevated Bb-titer. In diagnostic subgroups, the same correlations were only demonstrated for PNS disorders (n = 134), and especially PNS-disorders without compression. 8 cases showed the high risk constellation inflammatory CSF syndrome and highly positive titer (Bb-IgG 1: greater than or equal to 256). Only 2 had typical neuroborreliosis, while in 2 cases the possibility of neuroborreliosis was open. Patients with MS did not show a special risk for Bb-infection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiological aspects of neurological complications of Lyme borreliosis in Switzerland. A case-control study]. / Epidemiologische Aspekte der neurologischen Komplikationen der Lyme-Borreliose in der Schweiz.Eine Fall-Kontrollstudie.

To determine the individual relative risk to neurologically affected patients of infection with Borrelia burgdorferi, within the framework of a multicenter case control study encompassing the four neurological departments of the Universities of Basel, Bern, Zurich and Lausanne, 378 patients and 1134 healthy blood donors serving as controls underwent analysis for antibodies against Borrelia burgdorferi by ELISA. The seroprevalence were estimated for a cut-off point of 2 standard deviations from the mean, these values corresponding to cut-off points of 1:32 for IgM and 1:256 for IgG by immunofluorescence testing. For IgM, 4.8% of the neurological patients were positive versus 4.1% of controls; the corresponding values for IgG were 10.1% versus 10.7% respectively. Hence, neurologically affected patients were not at higher risk for infection with Borrelia burgdorferi than were controls. We found no elevated relative risk in any diagnostic subgroup. The results of a positive Lyme serology must therefore be interpreted with care and in relation to clinical and CSF findings. On the basis of our results, screening for Lyme borrelioses serves no purpose.