American Journal of Medicine
Volume 120, Issue 4, 2007, Pages 350-356

TB in a Low-Incidence Country: Differences Between New Immigrants, Foreign-Born Residents and Native Residents (Article)

Laifer G.* , Widmer A.F. , Simcock M. , Bassetti S. , Trampuz A. , Frei R. , Tamm M. , Battegay M. , Fluckiger U.
  • a Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland
  • b Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland
  • c Basel Institute of Epidemiology, University Hospital Basel, Switzerland
  • d Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland
  • e Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland
  • f Division of Microbiology, University Hospital Basel, Switzerland
  • g Division of Pneumology, University Hospital Basel, Switzerland
  • h Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland
  • i Division of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Switzerland

Abstract

Background: New immigrants and foreign-born residents add to the burden of pulmonary tuberculosis (TB) in low-incidence countries. The highest TB rates have been found among recent immigrants. Active screening programs are likely to change the clinical presentation of TB, but the extent of the difference between immigrant and resident populations has not been studied prospectively. Methods: Adult new immigrants were screened upon entry to 1 of 5 immigration centers in Switzerland. Immigrants with abnormal chest radiographs were enrolled and compared in a cohort study to consecutive admitted foreign-born residents from moderate-to-high incidence countries and native residents presenting with suspected TB. Results: Of 42,601 new immigrants screened, 112 had chest radiographs suspicious for TB. They were compared with foreign-born residents (n = 118) and native residents (n = 155) with suspected TB (n = 385 patients included). Active TB was confirmed in 40.5% of all patients (immigrants 38.4%, foreign-born residents 50%, native residents 34.8%). Clinical signs and symptoms of TB and laboratory markers of inflammation were significantly less common in immigrants than in the other groups with normal results in >70%. The proportion of positive results on rapid testing to detect M. tuberculosis (MTB) in 3 respiratory specimens was significantly lower in immigrants (34.9% for acid-fast staining; 55.8% for polymerase chain reaction) compared with foreign-born residents (76.2% and 89.1%, respectively) and native residents (83.3% and 90.9%, respectively). Isoniazid resistance and multi-drug resistance were more prevalent in immigrants. Conclusion: New immigrants with TB detected in a screening program are often asymptomatic and have a low yield of rapid diagnostic tests but are at higher risk for resistant MTB strains. Postmigration follow-up of pulmonary infiltrates is essential in order to control TB among immigrants, even in the absence of clinical and laboratory signs of infection. © 2007 Elsevier Inc. All rights reserved.

Author Keywords

Screening immigrants tuberculosis Clinical presentation Residents Foreign-born

Index Keywords

immigrant Mediterranean Region Europe, Eastern Latin America Alcohol Drinking mass screening clinical feature human immigration comorbidity middle aged Asia controlled study priority journal Aged screening test Residence Characteristics laboratory test Humans lung tuberculosis Adolescent Antitubercular Agents male Tuberculosis, Pulmonary female Aged, 80 and over Risk Factors Africa symptom polymerase chain reaction prevalence Incidence Article multidrug resistance adult major clinical study isoniazid biological marker Immunohistochemistry thorax radiography cohort analysis Emigration and Immigration Drug Resistance, Bacterial Switzerland
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-33947586433&doi=10.1016%2fj.amjmed.2006.10.025&partnerID=40&md5=4ea70519129c3be95a93180e30388e10
DOI: 10.1016/j.amjmed.2006.10.025
ISSN: 00029343
Cited by: 39
Original Language: English