[The difficult diagnosis of tuberculosis].
In spite of alarming reports from third world and industrialized countries, no increase in the incidence of tuberculosis has been seen in Switzerland. This is mainly attributable to the consistently performed initial treatment with a multiple-drug combination and the good compliance of our patients. In Switzerland the diagnosis of tuberculosis is difficult, because of its low incidence (1990: 1229 reported cases), as well as its nonspecific initial symptoms. Screening tests are only indicated in high risk-populations with direct contact to infectious tuberculosis cases, inhabitants of centres for homeless or immigrants, foreign workers and HIV-positives. The fast introduction of the gene amplification method with the polymerase chain reaction (PCR) would allow bacteriologic diagnosis within 48 hours. This would be of great practical relevance, allowing a quicker initiation of therapy and with that, a decrease of infection risk for physicians and medical staff, especially in endoscopy-rooms, emergency- and intensive care units. In Switzerland the multiple-drug resistance of mycobacteria (against insoniazid, rifampicin and other antimycobacterial agents) is seen only rarely (0.7 to 1.3% of cases). In patients with origin from countries with frequent drug-resistance to isoniazid and even more in case of suspected multiple drug-resistance or high initial bacterial count (cavernous tuberculosis), an initial combination therapy with four different antimycobacterial drugs should be applied, until the result of the susceptibility-tests is available.
Brändli
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Zürcher Höhenklinik, Faltigberg-Wald.
D000995:Antitubercular Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004641:Emigration and Immigration; D006679:HIV Seropositivity / Q000150:complications; D006703:Ill-Housed Persons; D006801:Humans; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D013557:Switzerland; D014171:Transients and Migrants; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy
D000995:Antitubercular Agents
Die schwierigen Diagnosen der Tuberkulose.