Epidemiological and clinical features of 139 patients with tuberculosis at a teaching hospital in Italy (Pisa, 1996-2000)

Risk factors for tuberculosis in foreign-born people (FBP) in Italy: a systematic review and meta-analysis

In Italy, TB notifications in foreign-born people (FBP) are steadily increasing. To investigate this issue we did a meta-analysis on risk factors for FBP people. A systematic search was performed in PubMed and EMBASE from Jan-1980 to Jan-2013. We analysed HIV status, previous TB-treatment, intravenous drug use and alcohol abuse, and multidrug resistant TB. Odd ratio was used as a measure of effect. One and two-stages approaches were used. In the main analysis we used a 2-stages approach to include studies with only aggregate estimates. Among 1996 references, 18 fulfilled inclusion criteria. In TB-affected FBP people positive HIV-status was about 3 times higher than among Italians, after 1996 when combined antiretroviral therapy for HIV was introduced (OR: 2.91; 95%CI: 1.37; 6.17). No association was found between FBP and intravenous drug users in adults; after 1-stage meta-analysis foreign born people from highly endemic countries had a 4 times higher risk to be multidrug resistant TB than Italian people. Finally, TB-affected FBP were less likely than Italians to be alcoholics (OR: 0.10 95%CI: 0.01; 0.84) or of having received previous TB-treatment (OR: 0.55; 95%CI: 0.43; 0.71). An association of multidrug resistant TB with immigrant status as well as an association of Tuberculosis with HIV-positive status in foreign-born people are major findings of this analysis. Drugs and alcohol abuse do not appear to be risk factors for TB in FBP, however they cannot be discharged since may depend on cultural traditions and their role may change in the future along with the migratory waves. An effective control of TB risk factors among migrants is crucial to obtain the goal of TB eradication.

[Tuberculosis unit: case study of 10 years of activity (1999-2009)]

INTRODUCTION

The Pulmonology Service of a Central Hospital in Lisbon created a Unit dedicated to the treatment of tuberculosis (TB).

OBJECTIVES

Casuistic analysis and assessment of the predictive factors for in-hospital mortality, over a 10-years period.

MATERIAL/METHODS

Retrospective study, from April 1999 to September 2009, through the Statistical Package for the Social Sciences application for binary logistic regression.

RESULTS

In a total of 1917 patients, most were male (n=1450; 76%), Caucasian (76.6%), with an average age of 43±15.2 years, and 19.8% were immigrants. The retreatments were responsible for 26% of the hospitalizations. The presence of comorbidities was detected in 85.7%, particularly HIV infection (34.7%). The multidrug-resistant (MDR) and the extensively drug resistant (XDR) TB occurred in 6.6% and 6.8%, respectively. The average delay was 28.5±54.8 days, with the mortality rate at 8.6%. The mortality risk was more significant amongst men (OR 1.8; 95%CI 1.16-2.90; p<0.01), in patients with HIV infection (OR 3.7; 95%CI 2.47-5.49; p<0.001), and amongst those who presented MDR TB (OR 2.5; 95%CI 1.24-5.15; p<0.01) and XDR TB (OR 5.5; 95%CI 3.14-9.58; p<0.001).

CONCLUSIONS

A high percentage of patients presented comorbidities, namely HIV infection. The main factors associated with mortality were HIV infection, XDR TB and MDR TB.

Epidemiological profile of hospitalized patients with TB at a referral hospital in the city of Rio de Janeiro, Brazil

OBJECTIVE

To determine the epidemiological profile of inpatients at a TB referral hospital.

METHODS

This was a descriptive, retrospective study of the medical charts of patients with TB hospitalized at the Hospital Estadual Santa Maria (HESM), in the city of Rio de Janeiro, Brazil, between January of 2002 and December of 2003. Data were collected using a standardized form.

RESULTS

Of the 451 patients included in the study, 313 (69.4%) had been referred to the HESM from health care clinics, and 302 (67.0%) were male. Most of the patients were in the 30-59 year age bracket, 443 (98.2%) lived in the greater metropolitan region of Rio de Janeiro, and 298 (66.1%) lived in the city of Rio de Janeiro itself. The most common reason for hospitalization was poor health status (in 237, 52.5%). The most common comorbidity was AIDS (in 137, 30.4%). The most common signs and symptoms at admission were weight loss, fever and productive cough. Sputum smear microscopy was positive in 122 (71.0%) of the patients presenting with productive cough at admission. Of the 212 patients being retreated, 156 (73.6%) reported noncompliance with previous treatment. Regarding the outcome, 273 (65.8%) of the patients were referred to municipal health care centers, 83 (18.4%) died, 44 (9.8%) were cured, and 27 (6%) were discharged against medical advice.

CONCLUSIONS

Providing hospitals specializing in TB is relevant for TB control, especially in metropolitan regions. In addition to taking biosafety measures, these hospitals must be prepared to treat patients with TB-related comorbidities and social problems. This study has resulted in improvements at the HESM.