Background: The southern region of Israel has recently experienced an influx of African refugees from the Eastern Sub- Sahara desert area. These influxes have led to a significant increase in incidence of tuberculosis (TB) in that region. Objectives: To review the data of African refugees diagnosed with TB between January 2008 and August 2010 at a tertiary care regional hospital. Results: Twenty-five TB cases were diagnosed, 22 of which presented with pulmonary TB, 3 with extra-pulmonary TB (EPTB), and 7 with combined pulmonary and EPTB. Only one case had concomitant human immunodeficiency virus (HIV) infection and multidrug-resistant TB. Fifteen patients underwent extensive radiological investigations including chest, abdominal and spine computed tomography, 1 was reviewed by magnetic resonance imaging, and 9 underwent tissue biopsy. Eighteen patients were admitted as suspected TB and 4 as suspected pneumonia or pulmonary infiltrates that could have been defined as suspected TB. All 24 HIV-negative cases were sensitive to first-line drugs for TB, except for one case that was resistant to streptomycin and one to rifampicin. All patients responded well to first-line therapy. The average duration of hospitalization was 8.7 days (range 1-36). Following diagnosis 23 patients were transferred to a quarantine facility. Conclusions: We identified overutilization of medical resources and invasive procedures. For African refugees from the eastern Sub-Sahara who were HIV-negative and suspected of having TB, a sputum acid-fast smear and culture should have been the primary investigative tools before initiating treatment with four drugs (first-line), and further investigations should have been postponed and reserved for non-responders or for patients for whom the culture was negative. Physicians should maintain a high index of suspicion for EPTB in this population.

Refugees tuberculosis Africa

tertiary health care hospital admission extrapulmonary tuberculosis differential diagnosis Negro Africa south of the Sahara refugee sputum smear Human immunodeficiency virus infection Israel lung infiltrate peritoneal biopsy transbronchial biopsy patient transport human Refugees middle aged multidrug resistant tuberculosis length of stay Young Adult lymph node biopsy Humans Sputum pleura biopsy lung tuberculosis tuberculostatic agent clinical examination male Treatment Outcome female tuberculosis Review nuclear magnetic resonance imaging clinical article Incidence infection control health care utilization streptomycin adult isoniazid pneumonia antibiotic sensitivity computer assisted tomography antibiotic resistance rifampicin bacterium culture mixed infection