Risk factors for tuberculosis

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There are a number risk factors for tuberculosis infection; worldwide the most important of these is HIV. Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries. [1] [2] Smoking more than 20 cigarettes a day increases the risk of TB by two to four times [3] while silicosis increases the risk about 30 fold. [4] Diabetes mellitus is also an important risk factor that is growing in importance in developing countries. [5] Other disease states that increase the risk of developing tuberculosis are Hodgkin lymphoma, end-stage renal disease, chronic lung disease, malnutrition, and alcoholism. [6] A person's genetics also play a role. [7]

Contents

Silicosis

People with silicosis have an approximately 30-fold greater risk for developing TB. [4] Silica particles irritate the respiratory system, causing immunogenic responses such as phagocytosis, which results in high lymphatic vessel deposits. [8] It is probably this interference and blockage of macrophage function that increases the risk of tuberculosis. [9] Persons with chronic kidney failure and also on hemodialysis have an increased risk. [10] Given that silicosis greatly increases the risk of tuberculosis, more research about the effect of various indoor or outdoor air pollutants on the disease would be necessary. Some possible indoor sources of silica include paint, concrete, and Portland cement. Crystalline silica is found in concrete, masonry, sandstone, rock, paint, and other abrasives. The cutting, breaking, crushing, drilling, grinding, or abrasive blasting of these materials may produce fine silica dust. It can also be in soil, mortar, plaster, and shingles. [11]

Some drugs, including rheumatoid arthritis drugs that work by blocking tumor necrosis factor-alpha (an inflammation-causingcytokine), raise the risk of activating a latent infection due to the importance of this cytokine in the immune defense against TB. [12]

HIV

HIV is a major risk factor for tuberculosis. The risk of developing TB is estimated to be between 20 and 37 times greater in people living with HIV than among those without HIV infection. TB is a leading cause of morbidity and mortality among people living with HIV. [13] In 2009, there were 9.4 million new cases of TB, of which 1.2 (13%) million were among people living with HIV. Of the 1.7 million people who died of TB, 400,000 (24%) were living with HIV. [13]

Nutrition

Low body weight is associated with risk of tuberculosis. A body mass index (BMI) below 18.5 increases the risk by 2 to 3 times. An increase in body weight lowers the risk. [14] People with diabetes mellitus are at increased risk of contracting tuberculosis, [15] and they have a poorer response to treatment, possibly due to poorer drug absorption. [16]

Other clinical conditions that have been associated with active TB include gastrectomy with attendant weight loss and malabsorption, jejunoileal bypass, renal and cardiac transplantation, carcinoma of the head or neck, and other neoplasms (e.g., lung cancer, lymphoma, and leukemia). [4]

Diet may also modulate risk. For example, among immigrants in London from the Indian subcontinent, vegetarian Hindu Asians were found to have an 8.5 fold increased risk of tuberculosis, compared to Muslims who ate meat and fish daily. [17] Although a causal link is not proved by this data, [18] this increased risk could be caused by micronutrient deficiencies: possibly iron, vitamin B12 or vitamin D. [17] Further studies have provided more evidence of a link between vitamin D deficiency and an increased risk of contracting tuberculosis. [19] [20] Globally, the severe malnutrition common in parts of the developing world causes a large increase in the risk of developing active tuberculosis, due to its damaging effects on the immune system. [21] [22] Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty. [23] [24]

Crowding

Prisoners are particularly vulnerable to infectious diseases such as HIV/AIDS and TB. Imprisonment facilities provide conditions that allow TB to spread rapidly due to overcrowding, poor nutrition, and a lack of health services. TB outbreaks have been reported in prisons and jails throughout the world, and is particularly concerning in the United States, [25] which incarcerates a larger proportion of its population than any other nation. The prevalence of TB in prisons is much higher than among the general population—in some countries as much as 40 times higher. [26] [27]

Diabetes mellitus

There is also a very high 3 fold increased risk of infection with TB for patients who have diabetes mellitus. [28] Higher associations have been found between diabetes mellitus and TB in study populations from Central America, Europe, and Asia. [28] Developing countries with exponential economic growth such as India and China that account for 40% of incident TB cases in 2010 and are estimated to have a 69% increase in people with diabetes mellitus are of concern for the joint burden of disease between diabetes mellitus and tuberculosis. [28]

Other

Other conditions that increase risk include the sharing of needles among IV drug users, recent TB infection or a history of inadequately treated TB, chest X-ray suggestive of previous TB, showing fibrotic lesions and nodules, prolonged corticosteroid therapy and other immunosuppressive therapy, compromised immune system (30–40% of people with AIDS worldwide also have TB), hematologic and reticuloendothelial diseases, such as leukemia and Hodgkin's disease, end-stage kidney disease, intestinal bypass, chronic malabsorption syndromes, vitamin D deficiency, [29] and low body weight. [6] [30] There is also genetic susceptibility. [7]

Related Research Articles

<span class="mw-page-title-main">Tuberculosis</span> Infectious disease

Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis. Around 10% of latent infections progress to active disease that, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss. Infection of other organs can cause a wide range of symptoms.

<span class="mw-page-title-main">Autoimmunity</span> Immune response against an organisms own healthy cells

In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". Prominent examples include celiac disease, diabetes mellitus type 1, Henoch–Schönlein purpura, systemic lupus erythematosus, Sjögren syndrome, eosinophilic granulomatosis with polyangiitis, Hashimoto's thyroiditis, Graves' disease, idiopathic thrombocytopenic purpura, Addison's disease, rheumatoid arthritis, ankylosing spondylitis, polymyositis, dermatomyositis, and multiple sclerosis. Autoimmune diseases are very often treated with steroids.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Other symptoms include increased hunger, having a sensation of pins and needles, and sores (wounds) that heal slowly. Symptoms often develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Pott's disease</span> Tuberculosis of the spine

Pott's disease, or Pott disease, named for British surgeon Percivall Pott who first described the symptoms in 1799, is tuberculosis of the spine, usually due to haematogenous spread from other sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are most often affected.

<span class="mw-page-title-main">Neutropenia</span> Abnormally low concentration of neutrophils (a type of white blood cell) in the blood

Neutropenia is an abnormally low concentration of neutrophils in the blood. Neutrophils make up the majority of circulating white blood cells and serve as the primary defense against infections by destroying bacteria, bacterial fragments and immunoglobulin-bound viruses in the blood. People with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening.

<span class="mw-page-title-main">Marasmus</span> Medical condition

Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases before age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus has inadequate energy intake in all forms, including protein. This clear-cut separation of marasmus and kwashiorkor is however not always clinically evident as kwashiorkor is often seen in a context of insufficient caloric intake, and mixed clinical pictures, called marasmic kwashiorkor, are possible. Protein wasting in kwashiorkor generally leads to edema and ascites, while muscular wasting and loss of subcutaneous fat are the main clinical signs of marasmus, which makes the ribs and joints protrude.

<span class="mw-page-title-main">Isoniazid</span> Antibiotic for treatment of tuberculosis

Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis, it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. For latent tuberculosis, it is often used alone. It may also be used for atypical types of mycobacteria, such as M. avium, M. kansasii, and M. xenopi. It is usually taken by mouth, but may be used by injection into muscle.

<span class="mw-page-title-main">Silicosis</span> Pneumoconiosis caused by inhalation of silica, quartz or slate particles

Silicosis is a form of occupational lung disease caused by inhalation of crystalline silica dust. It is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lungs. It is a type of pneumoconiosis. Silicosis, particularly the acute form, is characterized by shortness of breath, cough, fever, and cyanosis. It may often be misdiagnosed as pulmonary edema, pneumonia, or tuberculosis. Using workplace controls, silicosis is almost always a preventable disease.

<span class="mw-page-title-main">Diagnosis of tuberculosis</span> Methods for diagnosing tuberculosis

Tuberculosis is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it.

<span class="mw-page-title-main">Management of tuberculosis</span> Disease treatment

Management of tuberculosis refers to techniques and procedures utilized for treating tuberculosis (TB), or simply a treatment plan for TB.

Syndemics is the evaluation of how social and health conditions arise, in what ways they interact, and what upstream drivers may produce their interactions. The word is a blend of "synergy" and "epidemics". The idea of syndemics is that no disease exists in isolation and that often population health can be understood through a confluence of factors that produces multiple health conditions that afflict some populations and not others. Syndemics are not like pandemics ; instead, syndemics reflect population-level trends within certain states, regions, cities, or towns.

Latent tuberculosis (LTB), also called latent tuberculosis infection (LTBI) is when a person is infected with Mycobacterium tuberculosis, but does not have active tuberculosis (TB). Active tuberculosis can be contagious while latent tuberculosis is not, and it is therefore not possible to get TB from someone with latent tuberculosis. Various treatment regimens are in use for latent tuberculosis. They generally need to be taken for several months.

Diseases of poverty, also known as poverty-related diseases, are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.

<span class="mw-page-title-main">Health in Vietnam</span>

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<span class="mw-page-title-main">Health in Bangladesh</span>

Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.

Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.

<span class="mw-page-title-main">Signs and symptoms of HIV/AIDS</span>

The stages of HIV infection are acute infection, latency, and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, rash, muscle pain, malaise, and mouth and esophageal sores. The latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts, various opportunistic infections, cancers, and other conditions.

The co-epidemic of tuberculosis (TB) and human immunodeficiency virus (HIV) is one of the major global health challenges in the present time. The World Health Organization (WHO) reported that TB is the leading cause of death in those with HIV. In 2019, TB was responsible for 30% of the 690,000 HIV/AIDS related deaths worldwide and 15% of the 1.4 million global TB deaths were in people with HIV or AIDS. The two diseases act in combination as HIV drives a decline in immunity, while tuberculosis progresses due to defective immune status. Having HIV makes one more likely to be infected with tuberculosis, especially if one's CD4 T-cells are low. CD4 T-cells below 200 increases one's risk of tuberculosis infection by 25 times. This condition becomes more severe in case of multi-drug (MDRTB) and extensively drug resistant TB (XDRTB), which are difficult to treat and contribute to increased mortality. Tuberculosis can occur at any stage of HIV infection. The risk and severity of tuberculosis increases soon after infection with HIV. Although tuberculosis can be a relatively early manifestation of HIV infection, the risk of tuberculosis progresses as the CD4 cell count decreases along with the progression of HIV infection. The risk of TB generally remains high in HIV-infected patients, remaining above the background risk of the general population even with effective immune reconstitution and high CD4 cell counts with antiretroviral therapy.

Associations have been shown between vitamin D levels and several respiratory tract infections suggesting that vitamin D deficiency may predispose to infection. Outbreaks of respiratory infections occur predominantly during months associated with lower exposure to the sun. While Institute of Medicine concluded in a 2011 report that the existing data were "not consistently supportive of a causal role" for vitamin D in reducing the risk of infection, other reviews suggest that vitamin D supplementation can provide a protective role in reducing the incidence or severity of respiratory infections.

A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.

References

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  15. ↑ Restrepo, BI (2007). "Convergence of the tuberculosis and diabetes epidemics: renewal of old acquaintances". Clin Infect Dis. 45 (4): 436–8. doi:10.1086/519939. PMC   2900315 . PMID   17638190.
  16. ↑ Nijland HMJ, et al. (2006). "Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes". Clin Infect Dis. 43 (7): 848–854. doi: 10.1086/507543 . hdl: 2066/49893 . PMID   16941365.
  17. 1 2 Strachan DP, Powell KJ, Thaker A, Millard FJ, Maxwell JD (February 1995). "Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians". Thorax. 50 (2): 175–80. doi:10.1136/thx.50.2.175. PMC   473919 . PMID   7701458.
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  24. ↑ Spence DP, Hotchkiss J, Williams CS, Davies PD (1993). "Tuberculosis and poverty". BMJ (Clinical Research Ed.). 307 (6907): 759–61. doi:10.1136/bmj.307.6907.759. PMC   1696420 . PMID   8219945.
  25. ↑ "Increased US Prison Population Has Profound Demographic Consequences, Disproportionately Affecting Black Males". Medicalnewstoday.com. Retrieved 2011-10-24.
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  28. 1 2 3 Harries, A. D., et al. "Defining the Research Agenda to Reduce the Joint Burden of Disease from Diabetes Mellitus and Tuberculosis " Tropical medicine & international health : TM & IH (2010) Web.
  29. ↑ Nnoaham KE, Clarke A (2008). "Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis". Int J Epidemiol. 37 (1): 113–19. doi: 10.1093/ije/dym247 . PMID   18245055.
  30. ↑ "Core Curriculum on Tuberculosis: What the Clinician Should Know" (4th ed.). Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination. 2000.
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