European Society of Mycobacteriology - Instituto Nacional de Saúde ...

PP-60
ISOLATION AND FREQUENCY OF Mycobacterium sp IN A
GENERAL HOSPITAL DURING A 9-YEAR PERIOD
Portugal C.; Sancho L.; Dias A.; Tancredo L.; Silva M.; Sardinha T.; Sousa Germano
Laboratory of Microbiology, Department of Clinical Pathology
Hospital Fernando Fonseca – Amadora, Portugal
mclaraportugal@hotmail.com
Tuberculosis remains a major public heath problem in Portugal with an incidence rate of 25,3/100.000 inhabitants in 2008,
being the majority of the cases in the surroundings of the two major cities (Lisbon and Oporto).
Our Hospital is located in the Lisbon’s surroundings and covers a population of 750.000 inhabitants most of them with
poor socioeconomic level and immigrants from Africa and East Countries.
Purpose
The aim of this study was to investigate the isolation frequency of Mycobacterium sp. in a general Hospital in Amadora,
Portugal, during a 9-year period (2000-2008).
Methods
A total of 19.417 clinical specimens (15.159 pulmonary and 4.261 extra pulmonary), collected from 9.525 patients, were
cultured for mycobateria. All specimens were processed by the NaCl-NaOH method as recommended by CDC, stained
by Ziehl-Neelsen, cultured on Lowenstein-Jensen and liquid medium MGIT. Identification was made with the technology
Genotype MTBDR plus (HAIN-Lifecience- Germany).
Results
Of the 19.417 cultured specimens for mycobateria, 2751 (14,2%) were positive by cultural methods.
The positive rates by clinical specimen were: 17% (279/1684) in respiratory specimens and 6% (26/476) in extra pulmonary
tuberculosis; 21% (5/23) in pus, 11% (2/14) in biological liquids, 8% (5/66) in biopsy, 6% (7/112) in blood, 5% (1/22)
in ascitics fluid, 4% (1/22) in mieloculture, and 3% in urine (4/133) and cerebrospinal fluid (2/84).
In 9525 suspected TB patients, 1094 were effective tuberculosis cases (122 TB cases/year average, 97 cases in 2008). The
incidence rate by patient was 11,5%.
In comparison with the positive results of the culture, Ziehl-Neelsen stain was positive in 39% of the samples (47% of
the patients).
96% (1029) of mycobateria isolated were Mycobacterium tuberculosis Complex, 2% (20) M.avium, 2% (20) other species
(M.chelonae, M.intracellulare, M.alsiensis / malmoense / szulgai, M.scrofulaceum, M.lentiflavum).
Conclusion
In spite of the increase of TB suspected patients (+11,3%), the number of effective tuberculosis cases have decreased
(-7,8%) for a 9-year period, which is comparable to 2008 national data (-7,2%) in the last decade.
Tuberculosis is a major problem in this area with an recovery rate of 14,2% in the clinical specimens that we receive and
in 11,5% of the patients, most of them with Mycobacterium tuberculosis Complex (96%).
We have one positive patient every 3 days.
In attempt to minimize the impact of this disease, that depend on a large number of factors, we know that the laboratory
plays an important role in making a definitive diagnosis in a short time period (ASAP). We also know that is important a
close relation between the microbiology laboratory and the hospital doctors and also with the centre that follows the
patients in the community (CDP). This is our policy.
132 ESM 2009