Psychiatric Disorders: Risk Factor for Unsuccesful Treatment of TB Cases in Romania

SESSION TITLE: Tuberculosis SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Tuberculosis and psychiatric diseases share common risk factors (poverty, homelessness, HIV positive serology, alcohol/substance abuse) leading to frequent comorbidity. Begining with 2002, the incidence of TB in Romania is continuously decreasing: 142.2% 000-2002, 105.5% 000-2008, 72.9% 000 - 2013, but Romania is one of the european contry with very high incidence. The aim of our study was to establish the impact of psihiatrical diseases between TB cases in Romania among 2010 - 2013 and also to follow the evolution of these cases compared by the TB cases in general population. METHODS: Using data from the National TB Control Program, we analyzed the evolution of the proportion of tuberculosis cases occurred at patient with psychiatric diseases between 2010 - 2013. The indicators used to reflect the evolution of TB in these groups were: the rate of TB at homeless people among all TB cases; bacteriological confirmation rate calculated as the rate of bacteriologically confirmed cases of all the studied cases; therapy success rate, calculated as the ratio of the number of patients with cured pulmonary TB or with completed treatment to the number of patients declared with pulmonary TB; mortality rate among TB cases at psihiatrical patients. RESULTS: Between 2010 and 2013, the number of TB cases at patient with mental illness and their percent among all TB patients increased (283=1,34% in 2010, 318=1,90% in 2013). The percent of new cases remains high (73,49% in 2010 73,58% in 2013). Mean age of these patients increased from 40.05±17.58 in 2010 to 43.01±17.97 in 2013; 63.67% of patients were men, more than 50% living in rural areas. Pulmonary localisation is predominent (87,69% of cases). Microscopic examination of sputum revealed acid-fast bacillus in less than 60% of TB cases each year; bacteriological confirmation in culture was 67,33% in 2011%, but only 61,8% in 2012. Only 54,68% in 2011 and 57,07% in 2013 of psychiatric TB patient were successfully treated. Mortality rate is higher that in general population with TB: 16,47% in 2011 and almost 25% in 2013. CONCLUSIONS: The number and rate of psychiatrical cases among TB patients is increasing. The bacteriological confirmation of these cases is lower that in general population,probably due to poor cooperation of these patients and difficulties in sputum prelevation for bacteriological exam. Concerning the results of treatment at that category of patients, we have to underline the high percent of failure and abandoned treatment (more than 18%) and mortality rate (25% in 2013). CLINICAL IMPLICATIONS: We consider the necesity of the campain of active depistation in patients mental illness not only for active TB, but also for LTBI. The close monitoring of cases during TB treatment both by respiratory specialist and psychiatrist is another hint for TB network. DISCLOSURE: The following authors have nothing to disclose: Mara Popescu-Hagen, Rodica Traistaru, Mihaela Tanasescu, Nicoleta Cioran, Paraschiva Postolache No Product/Research Disclosure Information