Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Abstract

Introduction: The constantly increasing immigration flows are influencing tuberculosis (TB) epidemiology in several European countries as well as in Italy. Extrapulmonary tuberculosis (EPTB) incidence rate is not decreasing and, among immigrants, it occurs in a remarkable number of cases. This study aimed to provide further insights regarding EPTB among natives and immigrants in a low TB burden and high immigrant receiving setting. Methodology: A total of 217 TB cases admitted to the University-Hospital of Ferrara from 2009 through 2015 were enrolled in the study. Clinical and demographical data including age, gender, origin, single comorbidities such as HIV status, chronic viral disease, chronic lung disease, diabetes, neoplasm, and multimorbidity were analyzed. Results: Of the 217 cases enrolled, 60.0% were immigrants and 40.0% natives, 68.7% presented pulmonary TB and 31.3% EPTB. By binary logistic regression, we observed that female gender (O.R. (95% C.I.): 1.95 (1.08-3.50), p < 0.05), Asian origin (5.70 (2.00-16.24), p < 0.001) and multimorbidity (6.42 (2.37-17.41), p < 0.001) were significantly associated to the development of EPTB compared to PTB. Nodal TB was the most common site of reactivation (56.5% among immigrants and 27.3% among natives). Conclusions: The data we found could be useful in increasing EPTB medical suspicion and decreasing EPTB diagnostic delay in low TB burden and high immigrant receiving settings.

Melioidosis In Suspected Recurrent Tuberculosis: A disease in disguise

“…B. pseudomallei is well known to cause latent infection [17], although it is not documented that whether the anti-tubercular treatment has any effect in suppressing the bacteria Bone and joint involvements like septic arthritis and osteomyelitis are very well-documented clinical presentations in melioidosis [18], whereas pulmonary involvement was more commonly observed in TB. The extra-pulmonary involvement is more common in melioidosis than TB and less challenging in diagnosis, still it is missed most often [19,20]. Deranged liver function tests along with hepatomegaly is another entity in this case, which is more common in melioidosis than TB [21].…”

Prevalence of extra‐pulmonary tuberculosis in Africa: A systematic review and meta‐analysis

“…Variation of immunity in populations such as the background prevalence of HIV [33], migration [34] and socio‐demographic determinants such as population age structure and sex [35] must at least partially account for variation. For example, new migrants in Italy are screened for TB using chest x‐ray [36] which could lead to diagnosis and subsequent treatment of PTB but not necessarily EPTB (except in the cases of concurrent PTB and EPTB infections). Hence the higher proportion of EPTB.…”

Extrapulmonary and Drug-Resistant Childhood Tuberculosis: Unveiling the Disease to Adopt the Optimal Treatment Strategy

“…EPTB prevalence among children remains significant, even with the availability of the Bacillus Calmette-Guerin (BCG) vaccine [2]. Moreover, EPTB is often associated with origins in Sub-Saharan Africa or Asia [6,7], and poverty stands out among major factors influencing its prevalence [8]. Severe forms such as tuberculous meningitis (TBM) and miliary TB can develop rapidly and need to be diagnosed and treated without delay, given the high risk of sequelae and death [3,9].…”