Biomedical subjects

D Danková

Publications and source records attributed to D Danková.

At least 19 recordsLinked to original sources

PubMed2002

[Tuberculosis in the Czech Republic in the year 2000].

BACKGROUND: Incidence of tuberculosis (TB) in the Czech Republic (CR) during the year 2000 was evaluated on the basis of newly detected cases as well the restriction of known TB sources by antituberculosis treatment. Data from compulsory reported TB cases in the TB register for the year 2000 were used as well as data from the analysis of treatment in cohorts of patients reported quarterly in 1999 and evaluated 12 months later. METHODS AND RESULTS: 1442 cases of new diseases and TB relapses were reported in 2000 (14.1/100,00). 1244 cases (12.1/100,000) were TB of the respiratory system, 198 cases (2.0/100,000) belonged to the extra-respiratory TB. 61.9% of cases were bacteriologically verified TB of the respiratory system. In comparison with the year 1999, the number of TB cases was lower by 11.7%, respectively by 9.3% in TB of the respiratory system. The positive trend in TB incidence recorded in CR since 1998 has continued. From 1442 cases of the TB, 916 were males (63.5%) and 526 females (36.5%). Majority of patients was older than 65 years. 143 (9.9%) of TB cases were patients born extra CR ("foreigners"), namely coming from Ukraine (41), Vietnam (16), and Romania (14). 74 patients died of tuberculosis, mostly those older than 65 years. The youngest was the 24-year-old Ukrainian and a 38 year old homeless person, the citizen of CR. The highest incidence of TB was in West Bohemia, in Prague and in North Moravia; the lowest incidence was in South Moravia and in South Bohemia. TB was identified because of patient's troubles (68.0%), in the risk groups (13.3%), and by examination of contact persons (4.7%). Other mycobacteriosis than TB was identified in 92 patients. The treatment was evaluated in 606 persons with the pulmonary TB, which was bacteriologically verified; analysis was done in cohorts of patients reported quarterly in 1999. 70.1 to 77.5% of patients in individual cohorts were successfully treated, in 3 patients the treatment failed and 9 patients interrupted the treatment. Remaining 25% of patients either died before or during the treatment. The high mortality rate resulted from the high age and other diseases in some of the patients. CONCLUSIONS: WHO includes CR between countries with low TB incidence. Within the stabile population of CR the continuous decrease of TB incidence should continue, unless some unfavourable effects occur.

Adult↗

PubMed2001

[Multiresistant tuberculosis in the Czech Republic in 1998 and causes of its occurrence].

Multidrug resistant tuberculosis (MDR-TB) belongs to the most serious forms of TB. The number of MDR-TB patients represents an indicator of the effectiveness of TB regimentation. The aim of the study was to determine the number of registered MDR-TB patients in CR in 1998 and to identify causes of the resistance. Analysis of clinical documentation of 27 patients with MDR-TB positive sputum was done in 1998. According to the documentation, this form of tuberculosis was not confirmed in 5 persons. Out of 22 patients with confirmed MDR-TB, 21 were males and one female. In 3 of them we could not reveal whether they had been cured with antituberculotics before MDR-TB developed. Such resistance was then classified as an initial form. In 19 patients we found that resistance developed during treatment. Those cases were classified as secondary forms. In 16 patients the secondary resistance was related to the interruption of treatment, which was done wantonly by the patients in 14 cases. The consistent treatment of the sensitive TB is therefore the best prevention for MDR-TB development. Incidence of MDR-TB cases has not been influenced by immigration from countries with high rate of occurrence of MDR-TB.

Czech Republic↗

PubMed2001

Screening of TB contacts by tuberculin skin tests in a low-incidence community by BCG vaccination.

A 36-year-old man, an unemployed waiter, a regular patron of two bars living in a Czech city suffered for about a year from disorders caused probably by tuberculosis (TB). When hospitalised, diabetes mellitus and extensive lung TB were diagnosed. TB was found also at the post mortem examination when the patient died one week later. Screening of his contacts by tuberculin skin tests (2TU RT23 W. Tw.80) provided data for analyzing the usefulness of tuberculin tests for monitoring of propagation of TB infection among BCG vaccinated population with high TB prevalence in the A statistically significant difference was found in tuberculin reactivity between 543 contacts and 232 individuals who had not reported contact with, the patient. A skin reaction of 12 mm and more was found in 55.6% contacts while only in 2.6% of those included in the second group. The high tuberculin reactivity was proved in the individuals exposed to massive TB infection. Neither BCG vaccination, nor possible previous contact with TB in the past seemed to influence the actual tuberculin reactivity in the group of non-contacts. Furthermore, it is indicative of the fact that unknown TB sources are rare among the Czech population. The high tuberculin reactivity is suggestive of a fresh infection and justifies the tuberculin testing and the application of chemoprophylaxis.

Adult↗

PubMed2001

Is quarterly cohort analysis useful for assessing treatment outcomes in a low incidence country?

SETTING: In the Czech Republic, a country regarded as having a low incidence of tuberculosis (TB), short-course chemotherapy (SCC) of TB has been implemented in routine practice country-wide. OBJECTIVE: To assess the outcome of SCC by quarterly cohort analysis of patients using the methodology recommended by the World Health Organization (WHO). DESIGN: Patients with newly detected bacteriologically confirmed pulmonary TB notified in 1998 were treated according to local recommendations (SCC) or with the WHO-recommended DOTS strategy. The type of chemotherapy and its outcome were evaluated 12 months later by quarterly cohort analysis. RESULTS: A total of 731 patients with bacteriologically confirmed pulmonary TB, 403 of them smear-positive, were assessed. The proportion of those treated under the DOTS strategy increased from 56.2% to 75.1%. Favourable treatment outcomes (cure or treatment completed) were achieved in 69.0% of patients in the first quarter and 74.0% in the fourth quarter. Only four treatment failures and 21 defaulters were recorded. A total of 129 patients (15-21% in different cohorts) died before or during treatment, mostly from causes not connected with TB. If this proportion were not taken into account, treatment efficacy would have attained 85%. CONCLUSIONS: Analysis of SCC based on quarterly cohorts proved feasible in routine conditions in a country with a low incidence of TB and ongoing TB control, and provided more information than once yearly analysis.

Adult↗

PubMed2000

[Tuberculosis in the Czech Republic in 1999].

Report is given on the tuberculosis (TB) prevalence and the new diseases monitoring in Czech Republic (CR) in 1999 using the register of notifiable TB diseases. 1631 new TB cases and relapse were notified (15.9/100,000 citizens). Majority TB cases, 1369 (13.3/100,000 citizens) were of the respiratory system and 262 TB cases were in other locations. 63% of the respiratory system diseases were bacteriologically verified. In comparison with the year 1998, the number of newly notified TB patients was 9.6% lower, number of TB cases of the respiratory system which were bacteriologically verified was 12.3% lower, cases of microscopically positive TB were 17.4% less frequent. Among the notified TB patients there were 91 foreigners. TB relapse was identified in 61 patients. Among the notified TB cases, 987 (60.5%) were males and 644 (39.5%) were females. In both sexes patients over 65 predominated. Prevalence of TB cases higher than the average for the whole state was found in Prague, northern and western Bohemia. Groups with TB prevalence higher than 50/100,000 citizens were identified (the risk groups). They include homeless people, drug addicts, asylum applicants, and prisoners. Due to subjective troubles of patients TB was diagnosed in 70.2% cases, by active investigation in 13.9% patients. Late TB diagnosis at autopsy came in 6.8% cases. Decease due to TB was notified in 79 patients. In 77 of them TB had not been diagnosed premortally. 106 new cases and relapses of non-TB mycobacterial disease were notified in 1999. The case of tuberculosis in CR was in 1999 restrainable. In comparison with 1998 significant decrease of TB prevalence in individual subgroups of TB disease was described (10 to 17%). Also the decrease of the long-term trend (10 years) of newly notified TB patients and TB of the respiratory system was depicted. It is necessary to maintain the quality and extend of the TB control program in order to prevent the new outbreak of TB disease.

Adult↗

PubMed2000

[Tuberculosis in the Czech Republic in 1998].

In Czech Republic (CR) the epidemiological situation in tuberculosis (TB) was evaluated in 1998 using the notification TB into the TB register. 1805 new TB cases and relapses were notified (17.5/100,000 citizens). Majority TB cases, 1535 (14.9/100,000 citizens) were of the respiratory system and 270 TB cases were in other localized Two thirds (988 cases = 9.6/100,000 citizens) of the respiratory system TB, were bacteriologically verified thereout 564 direct smear positive. Patients with lung TB only were 10% less frequent than those with respiratory system TB. 69 TB cases were identified in foreigners. Relapse of TB was found in 66 patients. Among the notified TB cases were 62.9% of males and 37.1% females. In both sexes patients over 70 predominated. In the medium age category males also prevailed. Due to subjective troubles of patients TB was passively identified in 72.2%, actively by the physician 12.9% were identified. Late TB diagnosis during section occurred at 5.4% of patients. During the last 9 years annual number of notified patients has not changed. Only the number of bacteriologically verified cases of the respiratory system TB decreased and number of not verified cases increased. Decease due to TB was notified in 73 (0.7/100,000 citizens) usually old patients. In 67 patients TB was diagnosed premortally or at section. Differences in TB prevalence were found in different regions. Higher numbers of the TB patients than in average for the whole state were found in Prague, northern and western Bohemia and in northern Moravia. 112 new cases and relapses of MOTT were reported in 1998. Notification of TB in CR was on a good level. State of TB morbidity was stabilised and under control. However, the decrease of numbers of bacteriologically verified cases and increase of not verified ones, causes of occurrence of microscopically positive diseases will be necessary to analyse and groups which will require higher dispensary care have to be recognised.

Adult↗

PubMed1995

[Tuberculosis in Central Europe. Comparison of the present situation and development of tuberculosis in the Czech Republic and in Germany 1991-1993].

Comparison of the position as regards tuberculosis in the Czech Republic (CR) and in the Federal German Republic (FRG), two neighbouring countries of the Central European region was made possible by an approximation of systems of health services in the two countries and by the common effort to standardize definitions of indicators of the epidemiological situation as regards tuberculosis according to international recommendations. The relative number of newly assessed diseases of all forms and at all sites was equal in the two countries in 1993 and did not differ significantly during the past three years. No significant differences were found on comparison of indicators of incidence classified by bacteriological confirmation, site and age distribution. In the GRF the position as regards TB during the past three years is considered stabilized without apparent changes; the same applies also to the CR. In the GRF TB in the domestic population (German population) and foreigners is evaluated separately, as foreigners account for 7.3% of the prevalence. Tuberculosis of foreigners influences in a significant way the general incidence in the GRF, in particular in younger age groups. It is due to the adverse situation as regards TB in countries from which immigrants come. Logistic comparison of indicators of the incidence revealed that the traditional stabilized system of health services in the GRF as well as the newly introduced system in the CR are biased by the same error as regards mandatory notification of all new cases of TB. The findings make it possible to assess priorities specific for the Central European area in the amended system of surveillance of TB in the CR.

Adolescent↗

PubMed1994

Six years' experience with the discontinuation of BCG vaccination. 4. Protective effect of BCG vaccination against the Mycobacterium avium intracellulare complex.

SETTING: In 1986, mass BCG vaccination of newborns was discontinued in an extensive territorial sample of neonates in the Czech Republic (30,000 infants annually). The non-vaccinated children have since been tuberculin tested at two-year intervals; those with continual or repeated intensive contact with animals in households or on farms were also tested with Mycobacterium avium intracellulare complex sensitin in addition to tuberculin. OBJECTIVE: Within the frame work of the surveillance programme the incidence of infection and disease caused by M. avium intracellulare complex (M. avium complex) was evaluated and the protective effect of BCG vaccination analysed. DESIGN: In 1986-93, out of 190,874 non-vaccinated children, 36 were found to be infected by M. avium complex; 27 of them developed disease, i.e. mycobacteriosis other than tuberculosis (MOTT). RESULTS: The annual risk of infection with M. avium complex was 4.8/100,000 children per year, of whom 3.6/100,000 developed mycobacteriosis. 24 patients suffered from swelling of cervical lymph nodes, 2 of mediastinal lymph nodes and one child had the disease localized both in cervical and mediastinal lymph nodes. The disease was verified bacteriologically in 9 children. Most of the diseased children had impaired immunity; a marked skin reactivity of M. avium complex sensitin was present in all infected children. Animal sources infected by M. avium complex were detected in 5 cases. Another 14 children also had close contact with animals but without proven M. avium complex infection. CONCLUSION: In non-BCG vaccinated children the incidence of lymphadenitis caused by M. avium complex was considerably higher than in vaccinated children. BCG cells possess antigenic determinants which confer protective immunity probably both against M. tuberculosis and against M. avium complex infections. It may thus be assumed that BCG vaccination protects both against pathogenic tubercle bacilli and M. avium complex. This should be taken into consideration before recommending discontinuation of mass BCG vaccination of newborns in areas with a high prevalence of M. avium complex infection.

Age Distribution↗

PubMed1994

Six years' experience with the discontinuation of BCG vaccination. 3. Transmission of tubercle bacilli in an unvaccinated population.

SETTING: Mass BCG vaccination of newborns has been discontinued since 1986 in one third of the Czech Republic (30,000 newborns annually) except for babies with a high risk of tuberculosis. OBJECTIVE: The transmission and risk of tuberculosis infection were evaluated in non-BCG-vaccinated children representing a population living in satisfactory socio-economic conditions. DESIGN: In 1986-92, of 184,648 children tuberculin tested at 2-year intervals, 283 were infected. RESULTS: The risk of infection was low (0.04%). Infections very rarely occurred in children below the age of 1 year and the highest rate was in children 2-3 years old. The sources of infection were found in the families of only one half of the youngest children and in 10% of the older ones. In the remaining children occasional contacts with sources outside the family must be taken into account, but the mode of contact and transmission of infection were not identified. The only factor contributing to tuberculosis transmission was the high population density. CONCLUSION: The risk of infection was low and identified sources of tuberculosis were rare in a stable population of children without evident risk factors. Children were infected by occasional contact with tuberculous cases outside of their families. The unfavourable factors associated with living in overcrowded industrialised settlements contributed to the risk of infection of non-BCG-vaccinated children.

Age Factors↗

PubMed1993

Six years' experience with the discontinuation of BCG vaccination. 1. Risk of tuberculosis infection and disease.

BCG vaccination programmes were introduced into Czechoslovakia 40 years ago under a quite different epidemiological situation than that of today. Compulsory mass BCG vaccination of infants born in a selected area was discounted in 1986, except for those having a high risk of contracting tuberculosis or those whose parents expressly asked for it. The aim of this study was to ascertain the risk of tuberculosis infection and breakdown rate from infection to disease in 165,854 newborns following a period of 6 years. The average risk of infection in children aged 0-6 years was low (0.046%). No identifiable factors increasing the risk of infection were found. Primary tuberculosis was diagnosed in 31 children (7/100,000 persons/year); this corresponds to a 15.5% breakdown rate from infection to disease. The majority of patients were symptom-free with minimal disease and detected in the course of regular check-ups. These findings indicate that the change from mass BCG vaccination to selective vaccination of high risk newborns can be recommended. Nevertheless social and economic aspects which involve migration, living conditions and the attitudes of the population, as well as of medical staff, to vaccination should also be taken into consideration.

Age Factors↗

PubMed1993

Six years' experience with the discontinuation of BCG vaccination. 2. Cost and benefit of mass BCG vaccination.

In 1986 the compulsory mass BCG vaccination of infants born in a selected area of the Czech Republic was abolished. The observed annual risk of tuberculous infection in children aged 0-6 years was below 0.1% and the annual risk of tuberculous disease 7/100,000. The increase of tuberculous cases among nonvaccinated children indicated a protective efficacy of BCG vaccine of 80%. A benefit analysis proved that the advantages and disadvantages of BCG vaccination were in balance. The number of nonvaccinated children developing tuberculosis was so small that mass application of BCG has been found to be redundant. The important advantage of not using the vaccination is the maintenance of the epidemiological and diagnostic value of tuberculin tests. The tests in connection with preventive chemotherapy remain an important tool, enabling control of infected individuals.

BCG Vaccine↗

PubMed1992

[Tuberculosis surveillance in the Czech Republic in 1990].

The authors evaluated data on the extent of the problem of tuberculosis and the effectiveness of control measures in the surveillance of TB in the Czech Republic (CR) in 1990. The data are assembled and monitored by the same method for a period of 10 years. The incidence of respiratory TB confirmed bacteriologically was 11.3/100,000 population, incl. 5.7/100,000 already direct smear positive cases. Since 1988 the incidence did not change, in 1990 it increased slightly. The mortality from TB remained low. A total of 0.8/100,000 patients died, mostly old people not treated for TB before death. The so-called risk factors which may have participated in the development of TB were analyzed. Two thirds of the patients were men. For advanced TB was more frequent in young and middle-aged men, while in old men less advanced TB, positive only on cultivation, predominated. In women the majority of patients was older than 65 years. As to risk factors in young patients lack of cooperation was proved, e. g. alcohol abuse in two thirds amount of other serious diseases. Treatment of TB patients was successful in 96%. Causes of therapeutic failures were lack of cooperation and complications of antituberculotic treatment. In-patient treatment lasted on average three months, treatment with antituberculotics a total of 9 months. In 1990 TB in the CR was supervised, the epidemiological situation was favourable and comparable with advanced European countries. TB remains, however, a serious health problem in the CR. It is important to define, screen and ensure intensive supervision of subjects with various so-called risk factors.

Adolescent↗

PubMed1991

Tuberculosis surveillance in the Czech Republic in 1989.

The authors report on tuberculosis situation in the Czech Republic (CR) in 1989 and compare the data with 1988. The incidence of all cases of respiratory TB was 15.5 and that of bacteriologically confirmed cases 11.1/100,000. The mortality from TB was also low (1/100,000). Two-thirds of the patients were detected because of the patients' complaints. This passive case - finding was, however, inadequate in subjects with a poor health consciousness. Active screening was restricted to subjects with a high risk of TB (in contact with tuberculosis, with different diseases, with socio-economic factors, migrating subjects, non-cooperating subjects). In 1989 for the first time in the CR stagnation of the incidence of bacteriologically confirmed TB of the respiratory organs was recorded. The number of patients (5.7/100,000) with TB with a microscopically positive bacteriological finding in sputum was also the same. A slowing down of the hitherto recorded favourable trend of TB must be foreseen. It will be important to maintain the contemporary system of TB surveillance.

Czechoslovakia↗

PubMed1990

[Surveillance of tuberculosis in the Czech Republic in 1989].

The authors report on the tuberculosis situation in the Czech Republic (CR) in 1989 and compare the data with 1988. The incidence of all cases of TB was 18.4/100,000, the incidence of all cases of respiratory TB 15.5 and that of bacteriologically confirmed cases 11.1/100,000. The mortality from TB was also low (1/100,000). Two-thirds of the patients were detected because of the patients' complaints. This passive screening was, however, inadequate in subjects with a poor health consciousness. Active screening was restricted to subjects with a high risk of TB (in contact with tuberculosis, with different diseases, with socio-economic factors, migrating subjects, non-cooperating subjects). In 1989 for the first time in the CR stagnation of the incidence of bacteriologically confirmed TB of the respiratory organs was recorded. The number of patients (5.7/100,000) with TB with a microscopically positive bacteriological finding in sputum was also the same. A slowing down of the hitherto recorded favourable trend of TB must be foreseen. It will be important to maintain the contemporary system of TB surveillance.

Czechoslovakia↗

PubMed1990

[The epidemiologic situation regarding tuberculosis and the effectiveness of tuberculosis surveillance in Bohemia in 1988].

In the CSR (10 million inhabitants) in 1988 the system of TB surveillance was completed which comprises the national TB programme, the central TB register and the evaluation TB unit. The incidence of respiratory TB in 1988 in the CSR was 15.5/100,000 population. In 71% of the patients the disease was confirmed by bacteriological examination (11.0/100,000 population). The incidence of extrapulmonary TB was 4.2/100,000 population. As compared with previous years, the number of patients declined except patients with already microscopically confirmed acid resistant rods in the sputum; their incidence, 5.5/100,000, remained the same in the CSR since 1986. In this incidence participated in particular middle-aged men. The prevalence of active TB of the respiratory system was 20.0/100,000 population. It was only 1.3 times higher than the incidence, because treatment of TB patients was successful and principles of dispensarization were respected. The number of deaths from TB was 98 (0.9/100,000). In 84 the diagnosis was established only during autopsy. The lethality was high in old people. The course of treatment was evaluated after one year in 1330 patients with respiratory TB diagnosed in 1987. Satisfactory therapeutic results were achieved in 98% of the patients. In the remaining (17) patients bacteriological negativization of the sputum did not occur due to complications of treatment or lack of patient cooperation. 70% of the patients had a therapeutic regime with rifampicin. In-patient treatment was emphasized; the total mean period of administration of antituberculotics was 9.3 months.

Aged↗

PubMed1989

[Tuberculosis control in Czechoslovakia in 1987].

The authors evaluated control measures and their impact on the epidemiological situation of tuberculosis in the CSR in 1987. All data on patients are reported and supplemented in the central register of patients; they are processed continuously. Two thirds of patients with TB of the respiratory system confirmed by bacteriological examination were detected during examination made because of complaints. In 13.3% of the patients it took more than three months before the diagnosis was established. A key position, as regards early detection of unknown TB patients, is held by doctors of the primary health care. The majority of patients with respiratory TB was middle-aged or in higher age groups. 17.2% of all patients suffered from diabetes, 6.6% from peptic ulcers. About one fifth of the patients were described as non-cooperating or alcoholics. Treatment adhered to principles of rational chemotherapy, using short-term therapeutic regimes. Satisfactory results were obtained in 98% of the patients. In 1987 a total of 2196 new cases of TB and relapses of TB of all localizations were reported, i.e. by 16% less than in 1986. Tuberculosis of the respiratory organs was recorded in 81% (1768) of the patients, extrapulmonary TB in 19% (428). The incidence of respiratory TB was 17/100,000 and the incidence of bacteriologically confirmed cases 11.8/100,000. Bacteriologically confirmed cases accounted for 69% of the incidence and cases with microscopically confirmed acid resistant rods in sputum for 48%.

Adult↗

PubMed1989

[Microepidemics of tuberculosis].

Persons with unknown tuberculosis exist even in countries with favourable situation of tuberculosis and contribute to the transmission of tuberculosis. The features and characteristics of 12 tuberculosis microepidemics observed in Czech Socialist Republic (10 mil. inhabitants) in 1983 to 1987 are described. The intensity of transmission of tuberculous infection is determined by the amount of tubercle bacilli excreted and by the duration of exposition. In 10 source cases bacilli were detected by direct smear examination. Eight microepidemics occurred in families, 4 at school. Prolonged close contact, as well as occasional exposure to the infection were demonstrated. There were infected 109 children and adults. Tuberculosis developed in 27 children and adults. The examination and follow-up of persons in contact with tuberculosis patients belong to the important control procedures.

Czechoslovakia↗

PubMed1989

[BCG vaccination in low risk tuberculosis; first experiences after the suspension of BCG vaccination of newborns in Czechoslovakia].

With the steadily declining risk of tuberculosis infection in CSR the question arose whether vaccination of infants remains worthwhile considering not only resources spent but also complications to vaccination vis-a-vis benefits derived. A prospective study has been designed in which BCG vaccination of newborns is discontinued in an area with 30,000 newborns yearly. In the period from April 1, 1986 to January 31, 1988 there were not vaccinated 43,428 children (84.8% of the newborns). The collaboration of mothers was good. The one year old non-vaccinated children were tested with 2 TU PPD RT 23 with Tween 80. The distribution of positive tuberculin reactions appears unimodal, relatively large reactions being absent. 8 children had reactions with 6 or more mm induration. That corresponds to a risk of infection of 0.04%. The project continues in the research area and might be extended to another area.

BCG Vaccine↗