Background: To study the incidence and clinical spectrum of tuberculosis in the metropolitan area of Málaga (Spain).
Methods: Prospective study which includes all patients who had a diagnosis of tuberculosis within the referral area of "Carlos Haya" Málaga Regional Hospital from March 1, 1993 to February 28, 1994.
Results: During the study period, there were 138 cases of tuberculosis, with an incidence of 43.7 cases/10(5) inhabitants. Ninety one cases (66%) were male, and the mean age (SD) was 33.2 (18.3), with 88% being less than 55 years old. Thirty six patients (26.1%) were HIV-infected. Extrapulmonary tuberculosis made up 27.5% of the cases, and was more frequent in HIV-infected patients (p < 0.01; odds ratio: 2.9; 95% CI: 1.2-7.1). The mean (SD) time to diagnosis was 54.3 (76) days. The diagnosis was microbiologically confirmed in 106 cases (76.8%), histologically in 14 cases (10.1%), and the remaining 18 cases (13.1%) were clinically diagnosed. The global rate of resistance was 10.8%. The rate of primary resistance was 4.6%, and the rate of multidrug-resistant tuberculosis was 3.1%. Eighty nine patients (77.4%) were cured, six patients (5.2%) stopped the treatment, 3 (2.6%) had relapses and 1 (0.9%) was considered a therapeutic failure; 16.7% of patients were lost for follow-up. Sixteen patients died and in nine of them (6.5%) the death was attributed to tuberculosis.
Conclusions: The incidence of tuberculosis in Málaga urban area is high. It mainly affects young males of unfavored socio-economic classes. HIV-infected patients account for a high percentage of the cases. The high number of productive cases and the long time to diagnosis evidence the shortcomings of our sanitary system. These facts, together with the high rate of non-compliance, of treatment may explain the seriousness of the current situation in our country.