[Conventional and molecular diagnosis in a group of patients with drug-resistant tuberculosis]. / Diagnostic conventional si molecular la un esantion de paciensi cu TB-DR.

Worldwide, although the incidence of the sensitive/susceptible tuberculosis diminished, the number of drug resistant tuberculosis is growing. The bacteriological diagnosis, genetic and phenotypic, becomes essential for the epidemic control. The resistance appears as a phenotypic expression of mutations from M. tuberculosis genome. The mutations that appear for Rifampicin are in region rpoB, for Isoniazid in region katG and inhA, for Ethambutol-embB, Quinolone-gyrA, Aminoglicozid and Cyclical Peptides-rrs. To follow the concordance of results of drug sensitivity test (DST) through phenotypic and genetic method, we analyzed a group of 40 patients with TB-DR. We performed drug susceptibility testing on Lowenstein-Jensen medium according to the instructions of the manufacturer. The strains were tested indirect genetic too, Genotype MTBDR plus forl INH and RIF and Genotype MTBDRsl for the second line drugs. The concordance between genetic method and the phenotypic method is 95%, 5% from the patients have different sensitivity to INH and RIF, butphenotypical they are resistant, meaning that they have other mutations undetected by the strip. The most common mutation in region rpoB is MUT3 (52%) associating the absence of band W8. Mutations in the region rpoB MUT1 and MUT2A are 12.5%, and 15% respectively. For high resistance to INH, the mostcommon isMUT1 forkatG 95% and forlow resistance to INHMUTI from region inhA-30%. For the second line drugs, the most frequent concordance between genetic method andphenotypic method is for EMB, of 30%, geneticallyspeaking the strains display no mutation in region embB, but are resistantin phenotypic method. For FQ, KAN, AMKand CAP the concordance between the two methods is of 100% to all tested strains. In conclusion, genetic methods have high sensitivity, they are fast and shorten significantly the diagnosis time.

[Tuberculosis in Romania. Problems and solutions]. / Tuberculoza in România. Probleme si solutii.

UNLABELLED: The analysis of the Management Unit of the National TB Programme (NTP) database, together with the reports of the TB county managers, allowed to the authors to identify some weaknesses of TB control in Romania in the recent years and to propose the appropriate measures. PROBLEMS: The marked decrease in the reduction of TB cases reported annually from 2,761 in 2005-2006, to 145 in 2007-2008 and the stagnation of mortality rate: 7.5 per ten thousand in 2007 and 7.6 per ten thousand in 2008. Deficiencies in data recording and reporting through informatic system of the NTP. Lack of financial resources for system maintenance and upgrade. Deficiencies in monitoring and control of mycobacterium resistance to antituberculous drugs phenomenon at national level. Sensitivity testing only for a small percentage of culture confirmed new TB cases (21%). Higher percentage of MDR in new TB cases compared to the results of national survey of mycobacterium drug resistance 2003-2004. Lack of personnel: 16 TB dispensaries without any pulmonologist, vacancies for 259 doctors, 436 nurses and 433 auxiliary personnel. Important deficiencies in the NTP network's infrastructure and logistics countrywide. Discontinuities in the supply with first and second line antituberculous drugs resulting in interruption of treatments. Lack of an officially endorsed protocol for the diagnosis, treatment and monitoring of cases with TB/HIV co-infection. Solutions: Revitalization of monitoring-supervision activities of the NTP running countrywide, provision with necessary financial resources to perform the scheduled visits in counties. Providing maintenance and upgrade of the informatic system for data collection. Implementation of the necessary measures in order to attract and maintain the personnel in the NTP network. Conduct the national survey of mycobacterium susceptibility to first and second line antituberculous drugs and drug susceptibility testing of the most culture confirmed TB cases. Restore the centralized procurement of TB drugs. Finalization and official endorsement of the protocol for TB/HIV co-infection initiated in 2004.