Project financed by the Norwegian Grants 2009 - 2014, within the RO 19 - Public Health Initiative.
We asked Dr. Daniela Homorodean how the national laboratory network looks now, what are the challenges of the specialists’ activity and what will the new equipment bring. This is what she said for us:
“For the current situation in Romania, doing a microscopic exam for tuberculosis control is not enough. For a better surveillance of the endemic we need, for each patient, microscopic exam, as well as culture and drug sensitivity test. In the sputum we examine routinely for the pulmonary tuberculosis there must be 10,000 bacilli per millilitre of product, for us to be able to see one bacillus at the microscopic exam.
When bacilli appear, which we see coloured through special colorations at the microscopic exam, the lesions of the lung are quite advanced. Then, using other methods, we increase the chances to highlight the bacilli in early stages of the diseases, when the lesions are not so advanced. Thus, the chances of curing with less scars and lesions on the lung increase, because tuberculosis is a treatable infectious disease which can be cured. But, if the lesions are too extended, then it is cured through fibrosation, a scar-like tissue is formed. It is a fibrous tissue which doesn’t allow the lung to normally expand and relax. The bigger the lesions, the more extended is the fibrosis.
There are about 100 laboratories that diagnose and have as scope of work the bacteriologic diagnosis of tuberculosis, spread in all the counties. In each county there is a lab doing tuberculosis diagnosis. Starting with 2003, we began to run visits in the laboratory network and we selected some enthusiasts among the colleagues working in TB labs, good professionals, willing to participate in the control and guidance visits in the laboratories in the country. Immediately after we had the opportunity to accredit the laboratories according to the EU quality standards. Initially, 38 laboratories out of 50 proposed got accreditation, because only those met the criteria. Through the methods we’ve had so far, we got results after two or two and a half months, when we found out whether the germs eliminated by the patients were sensitive to the antimicrobials or resistant.
In eight regional laboratories and two national ones – Bucharest and Cluj – we have now the possibility to run genetic testing, in 24 or 48 ours, for the presence of the microbe in the sputum and the resistance of that microbe to the most powerful drugs – Isoniazid and Rifampicine. The resistance to these two drugs defines the multidrug-resistant TB. If the microbe is resistant to these two drugs, other substances, more powerful and more expensive, some of them with toxic effects, should be added to the treatment. It is best if, from the beginning, the patients accept the treatment so that the microbes not gain resistance, follow exactly the treatment without missing one single doze and not give up some of the drugs, because they think that three or four are too many. It is a big mistake, because from a treatable and curable disease, the person can develop a form difficult to treat and maybe impossible to cure. Then, such a non-compliant patient could make other people ill, and they will have since the beginning drug resistant tuberculosis. To find out about these cases as soon as possible, the genetic tests received through the Norwegian funds are essential. These are equipments which function with specific reagents and need special fit-up design. The reagents are procured also from Norwegian funds.
Through these projects, 9 cars shall be procured for the transport of products from the periphery to the diagnostic centres, so that by collecting the products we shall have rapid and quality diagnosis. It is not at all cost-efficient to keep a laboratory that only tests 3 sputa per day.
In 1999 we had other funding from the World Bank and five laboratories received the same equipment for doing culture on liquid media. Through that project, the laboratories had reagents for one year. Then, due to lack of funding, some of the laboratories stopped their activity, some others continued, but at a very low level, for serious forms.
We have to make sure that all the laboratories provide comparable diagnosis. The patients are quite mobile during the months or years of illness and go from one hospital to another. Or maybe they travel, get sick and get another set of tests. The results are compared with the previous bacteriological tests and they should be comparable, so that the monitoring can be correct and real and we can use the same scale and system of expressing results. I really like to believe that we had good results in the laboratories. It’s not a pleasure to work daily with sputum – not the best sight – but if you can deal with it and consider it a necessity, then you understand the relief of establishing a positive diagnosis and telling the patient that they have tuberculosis, not cancer. It is indeed, a relief.”