INCIDENCE AND CURRENT CLINICAL SPECTRUM O F TUBERCULOSIS IN A METROPOLITAN-AREA IN THE SOUTH OF SPAIN

BACKGROUND: TO study the incidence and clinical spectrum of tuberculos is in the metropolitan area of Malaga (Spain). METHODS: Prospective st udy which includes all patients who had a diagnosis of tuberculosis wi thin the referral area of <<Carlos Haya>> Malaga Regional Hospital fro m March 1, 1993 to February 28, 1994. RESULTS: During the study period , there were 138 cases of tuberculosis, with an incidence of 43,7 case s/10(5) inhabitants. Ninety one cases (66%) were male, and the mean ag e (SD) was 33.2 (18.3), with 88% being less than 55 years old. Thirty six patients (26.1%) were HIV-infected. Extrapulmonary tuberculosis ma de up 27.5% of the cases, and was more frequent in HIV-infected patien ts (p < 0.01; odds ratio: 2.9; 95% CI: 1.2-7.1). The mean (SD) time to diagnosis was 54.3 (76) days. The diagnosis was microbiologically con firmed in 106 cases (76.8%), histologically in 14 cases (10.1%), and t he remaining 18 cases (13.1%) were clinically diagnosed. The global ra te of resistance was 10.8%. The rate of primary resistance was 4.6%, a nd the rate of multidrug-resistant tuberculosis was 3.1%. Eighty nine patients (77.4%) were cured, six patients (5.2%) stopped the treatment , 3 (2.6%) had relapses and 1 (0.9%) was considered a therapeutic fail ure; 16.7% of patients were lost for follow-up. Sixteen patients died and in nine of them (6.5%) the death was attributed to tuberculosis. C ONCLUSIONS: The incidence of tuberculosis in Malaga urban area is high . It mainly affects young males of unfavoured socio-economic classes. HIV-infected patients account for a high percentage of the cases. The high number of productive cases and the long time to diagnosis evidenc e the shortcomings of our sanitary system. These facts, together with the high rate of non-compliance, of treatment may explain the seriousn ess of the current situation in our country.