Evaluation of tuberculosis treatment results in Italy, report 1999

In Italy no national data on tuberculosis (TB) treatment results was available. In 1995 the A.I.P.O. (Italian Association of Hospital Pneumologists) TB Study Group, in collaboration with the Istituto Superiore di Sanità (technical branch of the Ministry of Health) started a prospective monitoring activity based on the World Health Organisation and the International Union Against Tuberculosis and Lung Disease recommendations. Data was collected from a representative network of TB units nation-wide, managing a significant proportion of all TB cases notified in Italy each year. Aim of this study was to analyse the case-finding and treatment results for 1999. 906 TB cases were reported (61.2% males; 36.2% immigrants), 714 (78.8%) being new cases. Of these cases 639 (70.5%) were pulmonary, 221 (24.4%) extrapulmonary cases and 46 (5.1%) both pulmonary and extrapulmonary. The main risk-factors for TB were history of recent contact, diabetes and alcohol abuse among native Italians, the human immunodeficiency virus-seropositive status and history of recent contact among immigrants. The majority of immigrants came from Africa and Asia, and had stayed in Italy for more than 24 months before diagnosis of TB. Thirty-five per cent (320/906) of pulmonary patients had a positive direct sputum smear examination for alcohol acid-fast bacilli; 22.5% were resistant to any drug (from combined monoresistance to rifampicin: 1.6%; combined multi-drug resistance: 4.8%). In 97% of cases the duration of treatment was < 12 months. The overall success rate (cured plus treatment completed excluding transferred out from the denominator) was 86%. A significantly higher percentage of deaths were recorded amongst native Italians (being age-related; p < 0.001) while immigrants had a higher default rate (p < 0.001).