Berklaveiki á Íslandi 1975-1986

Abstract

A retrospective survey of tuberculosis in Iceland for 1975-1986, using the National Tuberculosis Register and screening laboratories for bacteriological and histological diagnoses, revealed 321 cases. There was a decrease in incidence from 16.8 per 100 000 per year for 1975-1978 to 7.9 for 1983-1986. Sixty-seven percent of all cases were bacteriologically confirmed, and 84% of cases of pulmonary tuberculosis. The disease occurred in all age groups, with 35% of the cases among those aged 65 year or older. Seven percent of all cases had not been notified. Five percent of the patients died from tuberculosis within one year of diagnosis. Half of these were diagnosed post mortem. Pulmonary tuberculosis was the most common form. There was a statistically significant predominance among male patients with pulmonary tuberculosis. A high proportion of patients with pulmonary tuberculosis (42%) were positive on direct microscopy of sputum. On average, the diagnosis of pulmonary tuberculosis was made three months after the onset of symptoms. An unusually high proportion of cases or 40.5% involved non- respiratory sites. This might reflect the natural distribution of tuberculosis in a country with a low case rate, where the majority of cases (approximately 85% in this study) emerge from reactivation to remote infection. The most frequent localization of non-respiratory disease was in the extra-thoracic lymph nodes and the genitourinary system. Lymph node involvement was more common in women. Bacteriological confirmation in lymph node disease was low (39%). We conclude that in Iceland tuberculosis is still a disease to be reckoned with. There is evidence of delayed diagnosis causing unnecessary morbidity and mortality. Physicians must be on the alert for the possibility of tuberculosis in all age groups, but particularly among the aged.

Við afturvirka rannsókn á berklaveiki árin 1975-1986 fannst 321 tilfelli. Nýgengi lækkaði um 53% frá fyrsta þriðjungi tímabilsins til þess síðasta. Karlar voru 53,3%. Berklar komu fram á öllum aldri, 114 voru yngri en 45 ára. Greining var staðfest með ræktun hjá 68%. Ræktunarhlutfallið fór upp í 84% við lungnaberkla en niður í 39% við eitlaberkla. Lungnaberklar voru algengasta mynd sjúkdómsins og tíðari hjá körlum en konum. Hjá fjórum af hverjum 10 með lungnaberkla sáust sýrufastir stafir við smásjárskoðun á hráka. Hlutur berkla utan öndunarfæra (40,5%) var hár miðað við önnur lönd. Utan öndunarfæra voru berklar algengastir í eitlum og í þvag- og kynfærum. Eitlaberklar voru algengari hjá konum. Fimm prósent sjúklinganna dóu úr berklum, og þar af greindist helmingur eftir andlát. Þótt aðeins 12 af 10 000 skólabörnum sýni útkomu á berklaprófi nú eru enn allt að 40% sjötugra Íslendinga jákvæðir og er því enn langt í upprætingu berkla.