[A controlled survey comparing 2 short-term therapeutic regimes in lymph node tuberculosis]. / Enquête contrôlée comparant deux régimes thérapeutiques de courte durée dans la tuberculose ganglionnaire.

To study the efficacy of short term chemotherapy in the treatment of peripheral glandular tuberculosis a controlled trial was carried out in Algiers in March 1982 comparing two therapeutic regimes. All the patients admitted to the study presented with glandular tuberculosis which was proved either histologically or bacteriologically. They were recruited in three clinics serving the Algerian population and were required to live in Algiers. The two anti-tuberculous regimes used consisted of an initial phase of four drugs: Rifampicin (R), Isoniazid (H), Streptomycin (S) and Pyrazinamide (Z) every day for two months. This initial phase was followed by R.H. every day for four months in regime A, making six months treatment in all and for seven months in regime B making nine months treatment in all. 141 patients were thus admitted to the study, of whom 117 could be used for analysis at the end of treatment. Of these 68 were female making up 58% of the total. 12 patients or 10% were under 15 years of age. After two years of review following the end of treatment there were nine therapeutic failures (7.7%) of whom five were in regime A and four were in regime B (no significant difference). Amongst the failures large volume nodes persisted in three patients and two patients presented with new nodes. The lymph nodes increased in volume at the end of treatment in two cases; and finally two patients presented again with fistulae at the end of treatment. There were eight unfavourable outcomes in nine patients under observation during treatment or at the end of chemotherapy. There was only one failure noted some time after the finish of treatment at the end of two years of follow up.

[Results of a national tuberculosis survey carried out from 1980 to 1989 in Algeria]. / Résultats de l'enquête tuberculinique nationale realisée de 1980 à 1989 en Algérie.

SETTING: Algeria, where mass BCG vaccination is performed at birth, has a high prevalence of tuberculosis. OBJECTIVE: To measure the scale of the tuberculosis problem and the impact of the National Tuberculosis Control Programme set up in 1972, a tuberculin survey was performed at regular intervals from 1980-1989 in Algeria. DESIGN: The survey took place in the schools of five communities of differing socio-economic levels. During two visits five years apart, respectively 18,960 and 30,738 children aged 8.5 years were tested. During the second visit, 10,301 children aged 12.5 were included in the survey. RESULTS: The prevalence of infection in children with no scar, non-vaccinated or whose vaccination status was unknown, was 4.05% in 1980-1984 and 2.71% in 1985-1989. With an annual decrease of 7.8%, the annual risk of tuberculosis infection was 0.34% in 1980-1984 and 0.22% in 1985-1989. CONCLUSION: The results of the survey seem to indicate the continued abatement of the tuberculosis problem in the years to come. They also show that tuberculin surveys at regular intervals can be performed in high-prevalence countries where there is mass BCG vaccination at birth.

[Problems posed by tuberculosis in the world in 1982]. / Problèmes posés par la tuberculose dans le monde en 1982.

One hundred years after the discovery of the tubercle bacillus the struggle against tuberculosis still poses numerous problems on a world scale. Each year, 10 million new cases appear: nearly five million are highly contagious; 95% of these cases come from developing countries. The official notification system currently in force is imperfect but a reckoning of the annual infection risk, from a methodical enquiry into tuberculous disease gives exact information on the size of the problem and its evolutionary time scale in each country. This is the best epidemiological index currently available. The technical problems of the struggle against tubercle are resolved in theory: the selective detection of groups at risk, centered on a network of bacteriology laboratories enables identification of all the sources of infection; chemotherapy, becoming safer and safer, with a duration reduced to 6 or 9 months at the maximum and curing practically 100% of the patients; properly performed BCG vaccination reduces the risk of infantile tuberculosis. Operational problems remain the most serious. The greatest difficulties are seen in countries with the highest prevalence: they are linked to a global shortage of resources but also at times a poor utilisation of the resources available. A concerted international action could render antituberculous drugs and the appropriate sanitary technology to all countries. With a judicious use of available information and means each country could today achieve an effective national antituberculous programme.

[Tuberculosis morbidity between 1982 and 1990 in Algiers]. / La morbidité tuberculeuse de 1982 à 1990 en Algérie.

Information on notified tuberculosis cases collected by the Algerian Ministry of Health and Social Affairs (Ministère de la Santé et des Affaires Sociales Algérien) from 1982-1990 show that 13,916 cases were notified in 1982 and 10,864 in 1990, of which 67%-71% were cases of pulmonary tuberculosis (TP) and 25-29% cases of extrapulmonary tuberculosis (TEP). New cases of smear-positive TP represented 49-55.4% of all cases and the majority of TP (69-79% depending on the year). These forms particularly affected men aged between 20 and 39 and both men and women over the age of 60. The annual incidence of tuberculosis of all forms fell by 40.3% in 9 years, from 72 cases per 100,000 in 1982 to 43 cases in 1990. Similarly, the annual incidence of smear-positive TP fell from 32 per 100,000 to 22 cases (a decline of 37%), and mainly affected the age group 20-39 years. Lymphadenitis remained the most common TEP (a total of 32% in 1990), the fall in incidence of which was similar to that of TP, although slightly less marked. Whilst a firm diagnosis of new TP cases is provided mainly by direct smear examination, TEP are unfortunately rarely confirmed. The HIV pandemic, which has hardly touched Algeria as yet, does not for the moment play a significant role in tuberculosis morbidity in the community.