general practitioner | Acta Medica Marisiensis

In Romania, the detection, diagnosis, treatment and prophylaxis of tuberculosis (TB) is being preformed according to the “National Strategy for TB Control 2007–2011”, part of the National Program for the Control of TB 2007–2011 that has been approved by Government Decree. The program has been developed by Romanian experts and it observes the WHO requirements regarding the Global Control of TB in the world. The National Strategy for TB Control aims to maintain a 100% coverage of the WHO DOTS (Directly Observed Therapy in Short course) strategy for prevention of abandon, failures and disorganized treatments with missed doses that may lead to development of chemoresistant strains. It is obvious that the family physician in direct contact with the population is the most suitable to identify TB suspects and their contacts, and to contribute to the correct progress of the outpatient treatment of TB.

Evaluation of Diagnosing Tuberculosis in Primary Care Medicine in Mureș County, Between 2006 and 2008

Ács Valeria¹, Finta Hajnal², Ianosi Edith Simona³, Sabău Monica⁴

1 Doctoral School, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Hygiene, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pulmonology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Epidemiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0003

Aim: Evaluation of the contribution of general practitioners to the early diagnosis of tuberculosis in the studied period. Analysis of cases not diagnosed as active TB, from those suspected by the general practitioner and the real cases with respiratory lesions.
Material and methods: We conducted an observational epidemiologic study aiming at evaluating the diagnosis of pulmonary TB at the level of primary care medicine.
Results: The difference between conformed TB patients that have been referred with the suspicion of TB and those without suspicion is significant (p <0.0001), and the risk of disease estimated by OR was 21.54. More than half of the patients (139), had positive microscopic examination and culturing, representing 62.61%. In 10.36% microscopic examination was positive and culturing was negative (13 patients). Negative microscopic examination and positive culturing were detected in 5.86% of the patients. The majority of suspected/confirmed new patients were living in urban environments. The urban/rural ratio was 1.27. The reasons why the general practitioner suspected tuberculosis, in the order of frequency, were the following: cough/dry cough, sweating/nocturnal sweating, fever/persisting fever. Among the TB types, we noted the large percentage of patients with infiltrating, nodular tuberculosis confined to the volume of one pulmonary segment (30.78%), and 19.87% of the cases were multicavity tuberculosis; also, we noted the presence of caseous tuberculosis with moderate volumes of infiltrates, confined to a pulmonary lobe (18.27%).
Conclusion: Early diagnosis of tuberculosis in the primary healthcare network is a continuous challenge for the general practitioner.