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 an infectious 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 which, 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">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

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. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the 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">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">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">Tropical medicine</span> Interdisciplinary branch of medicine

Tropical medicine is an interdisciplinary branch of medicine that deals with health issues that occur uniquely, are more widespread, or are more difficult to control in tropical and subtropical regions.

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

Tuberculosis management describes the techniques and procedures utilized for treating tuberculosis (TB).

A syndemic or synergistic epidemic is the aggregation of two or more concurrent or sequential epidemics or disease clusters in a population with biological interactions, which exacerbate the prognosis and burden of disease. The term was developed by Merrill Singer in the early 1990s to call attention to the synergistic nature of the health and social problems facing the poor and underserved. Syndemics develop under health disparity, caused by poverty, stress, or structural violence and are studied by epidemiologists and medical anthropologists concerned with public health, community health and the effects of social conditions on health.

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. The main risk is that approximately 10% of these people will go on to develop active tuberculosis. This is particularly true, and there is added risk, in particular situations such as medication that suppresses the immune system or advancing age.

Diseases of poverty 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">Multidrug-resistant tuberculosis</span> Medical condition

Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medications (drugs): isoniazid and rifampin. Some forms of TB are also resistant to second-line medications, and are called extensively drug-resistant TB (XDR-TB).

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

Health in Vietnam encompasses general and specific concerns to the region, its history, and various socioeconomic status, such as dealing with malnutrition, effects of Agent Orange as well as psychological issues from the Vietnam War, tropical diseases, and other issues such as underdeveloped healthcare systems or inadequate ratio of healthcare or social workers to patients.

<span class="mw-page-title-main">Refugee health</span> Health effects experienced by people who have been displaced

Refugee health is the field of study on the health effects experienced by people who have been displaced into another country or even to another part of the world, as a result of unsafe circumstances such as war or persecution. People who have been displaced can be affected by infectious diseases or some chronic diseases that are uncommon in the country in which they eventually settle. Mental health is an important consideration and can greatly impact people who are displaced. The health status of refugee's can be tied to factors such as the person who migrated's geographic origin, conditions of refugee camps or urban settings where they lived, and personal, physical, and psychological conditions of the person, either pre-existing or acquired while traveling from their homeland to a camp or eventually to their new home.

<span class="mw-page-title-main">Autoimmune disease</span> Disorders of adaptive immune system

An autoimmune disease is a condition that results from an anomalous response of the adaptive immune system, wherein it mistakenly targets and attacks healthy, functioning parts of the body as if they were foreign organisms. It is estimated that there are more than 80 recognized autoimmune diseases, with recent scientific evidence suggesting the existence of potentially more than 100 distinct conditions. Nearly any body part can be involved.

<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">Tuberculosis in India</span> Health issue in India

Tuberculosis in India is a major health problem, causing about 220,000 deaths every year. In 2020, the Indian government made statements to eliminate tuberculosis from the country by 2025 through its National TB Elimination Program. Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.

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) reports 9.2 million new cases of TB in 2006 of whom 7.7% were HIV-infected. Tuberculosis is the most common contagious infection in HIV-Immunocompromised patients leading to death. These diseases act in combination as HIV drives a decline in immunity while tuberculosis progresses due to defective immune status. 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. A study on gold miners of South Africa revealed that the risk of TB was doubled during the first year after HIV seroconversion. Although tuberculosis can be a relatively early manifestation of HIV infection, it is important to note that 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.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.

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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  2. ↑ Chaisson, RE; Martinson, NA (2008-03-13). "Tuberculosis in Africa--combating an HIV-driven crisis". The New England Journal of Medicine. 358 (11): 1089–92. doi: 10.1056/NEJMp0800809 . PMID   18337598.
  3. ↑ Davies PD, Yew WW, Ganguly D, Davidow AL, Reichman LB, Dheda K, Rook GA (April 2006). "Smoking and tuberculosis: the epidemiological association and immunopathogenesis". Transactions of the Royal Society of Tropical Medicine and Hygiene. 100 (4): 291–8. doi:10.1016/j.trstmh.2005.06.034. PMID   16325875.
  4. 1 2 3 ATS/CDC Statement Committee on Latent Tuberculosis Infection (June 2000). "Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society". MMWR Recomm Rep. 49 (RR–6): 1–51. PMID   10881762.{{cite journal}}: |author1= has generic name (help)
  5. ↑ Restrepo, BI (2007-08-15). "Convergence of the tuberculosis and diabetes epidemics: renewal of old acquaintances". Clinical Infectious Diseases. 45 (4): 436–8. doi:10.1086/519939. PMC   2900315 . PMID   17638190.
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  8. ↑ Lee JH (1948). "Tuberculosis and Silicosis". Can Med Assoc J. 58 (4): 349–353. PMC   1591092 . PMID   18916106.
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  14. ↑ Leung CC (June 2007). "Lower risk of tuberculosis in obesity". Arch. Intern. Med. 167 (12): 1297–304. doi: 10.1001/archinte.167.12.1297 . PMID   17592104. Figures OI70054T5, OI70054F1 {{cite journal}}: External link in |quote= (help)
  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.
  18. ↑ Davis L (1995). "Vegetarian diet and tuberculosis in immigrant Asians". Thorax. 50 (8): 915–6. doi:10.1136/thx.50.8.915-c. PMC   474924 . PMID   7570453.
  19. ↑ Ustianowski A, Shaffer R, Collin S, Wilkinson RJ, Davidson RN (2005). "Prevalence and associations of vitamin D deficiency in foreign-born persons with tuberculosis in London". J Infect. 50 (5): 432–7. doi:10.1016/j.jinf.2004.07.006. PMID   15907552.
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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.
  26. ↑ "Tuberculosis: stopping a killer that can't be kept behind bars". ICRC. Retrieved 26 July 2011.
  27. ↑ Larouzé B, Sánchez A, Diuana V (2008). "Tuberculosis behind bars in developing countries: a hidden shame to public health". Trans. R. Soc. Trop. Med. Hyg. 102 (9): 841–2. doi:10.1016/j.trstmh.2008.04.020. PMID   18513772.
  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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