The aim of the present study was to determine the demographics of patients with extrapulmonary tuberculosis in Germany.Data on 26,302 tuberculosis cases from a national survey carried out during the period 1996-2000 were analysed.The crude proportion of tuberculosis patients with extrapulmonary manifestations was 21.6%. Extrapulmonary tuberculosis was most likely among females, children aged ,15 yrs and persons originating from Africa and Asia. Females tended to be more likely to have any form of extrapulmonary tuberculosis than males, except pleural tuberculosis. The strength of this association was strongest in the age range 25-64 yrs and less pronounced amongst the oldest patients. Children were particularly prone to the development of lymphatic and meningeal tuberculosis, whereas the likelihood of genitourinary tuberculosis increased with increasing age. Asian and African patients were generally more likely than persons from other areas to have lymphatic, osteoarticular, meningeal and miliary tuberculosis.The analysis shows important differences, by age, sex and origin, in the likelihood of a tuberculosis patient presenting with extrapulmonary tuberculosis. Since the relative contribution of the foreign-born to tuberculosis in low-prevalence countries is rising, extrapulmonary tuberculosis must be taken into account more often in the differential diagnostic work-up of these patients, particularly among those originating from Asia and Africa.

Background: BCG-vaccination can confound tuberculin skin test (TST) reactions in the diagnosis of latent tuberculosis infection.

A uniform case definition and a minimum set of variables for reporting on each case have been agreed which, when collated on a national basis, will allow comparison of the epidemiology of tuberculosis in different European countries.The Working Group recommends that the case definition includes "definite" cases, where the diagnosis has been confirmed by culture (or supported by microscopy findings in countries where diagnostic culture facilities are not available), and "other than definite cases" based on a clinical diagnosis of tuberculosis combined with the intention to treat with a full course of antituberculosis therapy. Both "definite" and "other than definite" cases should be notified by physicians and, in addition, laboratories should be required to report "definite" cases.The minimum set of variables to be collected on each case of tuberculosis should include: date of starting treatment, place of residence, date of birth, gender, and country of origin, to characterize the patient. Recommended disease-specific variables include: site of disease, bacteriological status (microscopy and culture), and history of previous antituberculosis chemotherapy.The minimum set of variables should be collated on all patients and should be as complete as possible. Additional variables may be collected for individual, local or national purposes, but, in general, completeness of reporting on cases is likely to be better if the information requested is kept to a minimum.Timely reporting of cases is essential for appropriate public health action. Cases should be reported to the health authority at the local and/or regional level within 1 week of starting treatment. Individual-case based information should be reported to the national level by the local or regional level. Feedback to reporters is essential. At the national level, preliminary quarterly reports should be produced and final reports should be published annually.

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ZusammenfassungZur Diagnostik der latenten tuberkulösen Infektion (LTBI) stand bislang lediglich der Tuberkulinhauttest (THT) zur Verfügung. Dieses Verfahren weist jedoch weder eine 100 %ige Sensitivität, noch ± und dies insbesondere aufgrund seiner Kreuzreaktogeni− tät mit BCG und Umweltmykobakterien ± eine 100 %ige Spezifität AbstractUp to now the diagnosis of latent tuberculosis infection (LTBI) was based solely on the tuberculin skin test. However, this me− thod offers neither 100 % sensitivity nor ± and this is in particular due to its cross−reactivity with BCG and environmental myco− bacteria ± a 100 % specificity. The demand in Germany for a more reliable in vitro test is currently enhanced by the change from the multipuncture test to the intradermal (Mendel−Man− toux) test and by the uncertainty resulting from the ceased pro− duction of the tuberculin previously used in Germany. The ma− nufacturers of immunologic test methods such as the QuantiFE− RON

Tuberkuloseepidemiologie in Deutschland und der Welt mit Schwerpunkt OsteuropaTuberkulose heutzutage weltweit ein schwerwiegendes Problem darstellt. Davon sind weniger die Industrienationen betroffen, sondern vor allem die Entwicklungsländer, in denen mehr als 95% aller Tuberkulosefälle auftreten. In diesen Ländern hat die Tuberkulose zwischenzeitlich oftmals eine weit größere Relevanz als noch vor 100 Jahren. Die Tuberkulosesituation weltweitWeltweit ist M. tuberculosis heutzutage der am häufigsten zum Tode führende Infektionserreger bei Jugendlichen und Erwachsenen, er verursacht in Entwicklungsländern mehr als ein Viertel aller vermeidbaren Todesfälle. In Abb. 1 sind die von der Weltgesundheitsorganisation (WHO) geschätzten Erkrankungszahlen an Tuberkulose für die letzte Dekade dargestellt,Abb. 2 zeigt die prozentuale Verteilung der Tuberkuloseneuerkrankungen für 1996 nach WHO-Regionen. Da oft keine validen Daten zur Tuberkuloseepidemiologie existieren, muß teilweise auf Schätzungen zurückgegriffen werden [4,5], deren Methodik und

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