[Have the incidence and resistance of tuberculosis increased? Epidemiologic follow-up based on diseases confirmed by culture].

The unexpected increase in the incidence of tuberculosis in many industrialized countries, which was recorded in Germany for the first time in 1992, provided the incentive for this retrospective analysis over the past 13 years of the epidemiology and resistance situation for Tbc in the Rhine/Main area. Basis for the evaluation were the data from our laboratory which is the only institution in the region performing type and resistance determinations on mycobacteria. During the period of the investigation, in which 3,738 tuberculoses were confirmed in cultures, the number of cases of the disease among German citizens decreased continuously. However, the still stagnating incidence rates can probably be attributed to the increasing flow of immigrants from countries with a high Tbc prevalence. Extrapulmonary manifestations were detected more often among foreigners than among Germans (19.6% versus 13.3%, p < 0.0001). In 9.5% of the cases, resistance against at least one of the five primordial antituberculosis agents (INH, SM, EMB, RMP, and PZA) was observed; but the rate was almost twice as high among foreigners as among Germans (13.8% versus 7.4%, p < 0.001). An increase in resistance either against individual substances or in regard to combination resistance could not be observed. In spite of the relatively high number of HIV-positive persons in the Frankfurt region, HIV-associated tuberculosis is still too seldom to make a noticeable impression on the total incidence. In the light of the regional incidence and resistance rates determined by us, a special position or even pace-setting function of our conurbation within the epidemiological tuberculosis situation in Germany cannot be recognized at present.