Article information
Abstract
The susceptibility to infection, the pathogenesis and the clinical manifestations of tuberculosis (TB) depend on the immunological status of the host. Immunological status is largely determined by age and comorbidities, but is also affected by other less well known factors. In Spain, most incidental cases of TB arise from the reactivation of remotely acquired latent infections and are favored by the aging of the population and the use of aggressive immunosuppressive therapies. The diagnosis and management of TB in these circumstances is often challenging. On the one hand, the atypical presentation with extrapulmonary involvement may delay diagnosis, and on the other, the toxicity and interactions of the antituberculous drugs frequently make treatment difficult. Immigration from resource-poor, high incidence TB countries, where the social and economic conditions are often suboptimal, adds a new challenge to the control of the disease in Spain. This chapter summarizes our current knowledge of epidemiological, clinical and treatment aspects of TB in particularly susceptible populations.
Keywords:
Tuberculosis
Immunosupression
Comorbidity
Immigration
Resumen
La susceptibilidad a la infección, patogenia y manifestaciones clínicas de la tuberculosis (TB) dependen de la situación inmunológica del hospedador, lo cual, a su vez, está determinado en gran medida por la edad y las comorbilidades, pero también por otros factores no bien conocidos. La mayor parte de casos nuevos de TB en España tiene su origen en la reactivación de una infección remota latente, y es favorecida por el envejecimiento y las terapias inmunosupresoras agresivas. A menudo, el diagnóstico y tratamiento de la TB en este contexto representan un reto. Las presentaciones atípicas, con afectación extrapulmonar, pueden retrasar el diagnóstico, pero además la toxicidad y las interacciones de los fármacos antituberculosos, a menudo, dificultan el tratamiento. La inmigración de países en vías de desarrollo y alta incidencia de TB, frecuentemente con condiciones sociales y económicas desfavorables, añade un nuevo reto al control de la enfermedad en España. En este capítulo se resume el conocimiento actual acerca de los aspectos epidemiológicos, clínicos y terapéuticos de la TB en poblaciones especialmente susceptibles.
Palabras clave:
Tuberculosis
Inmunosupresión
Comorbilidad
Inmigración
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References
[1.]
Targeted tuberculin testing and treatment of latent tuberculosis infection.
American Thoracic Society.
MMWR Recomm Rep, 49 (2000), pp. 1-51
[2.]
E.L. Corbett, C.J. Watt, N. Walker, D. Maher, B.G. Williams, M.C. Raviglione, et al.
The growing burden of tuberculosis: global trends and interactions with the HIV epidemic.
Arch Intern Med, 163 (2003), pp. 1009-1021
[3.]
A. Guerrero, J. Cobo, J. Fortún, E. Navas, C. Quereda, A. Asensio, et al.
Nosocomial transmission of Mycobacterium bovis resistant to 11 drugs in people with advanced HIV-1 infection.
Lancet, 350 (1997), pp. 1738-1742
[4.]
N.R. Gandhi, A. Moll, A.W. Sturm, R. Pawinski, T. Govender, U. Lalloo, et al.
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa.
Lancet, 368 (2006), pp. 1575-1580
[5.]
M.D. Keiper, M. Beumont, A. Elshami, C.P. Langlotz, W.T. Miller Jr.
CD4 T lymphocyte count and the radiographic presentation of pulmonary tuberculosis. A study of the relationship between these factors in patients with human immunodeficiency virus infection.
Chest, 107 (1995), pp. 74-80
[6.]
D.C. Perlman, W.M. El-Sadr, E.T. Nelson, J.P. Matts, E.E. Telzak, N. Salomon, et al.
Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG).
Clin Infect Dis, 25 (1997), pp. 242-246
[7.]
A.M. Baciewicz, C.R. Chrisman, C.K. Finch, T.H. Self.
Update on rifampin and rifabutin drug interactions.
Am J Med Sci, 335 (2008), pp. 126-136
[8.]
W.M. El-Sadr, S.J. Tsiouris.
HIV-associated tuberculosis: diagnostic and treatment challenges.
Semin Respir Crit Care Med, 29 (2008), pp. 525-531
[9.]
H.M. Blumberg, W.J. Burman, R.E. Chaisson, C.L. Daley, S.C. Etkind, L.N. Friedman, et al.
American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis.
Am J Respir Crit Care Med, 167 (2003), pp. 603-662
[10.]
W. Burman, D. Benator, A. Vernon, A. Khan, B. Jones, C. Silva, et al.
Acquired rifamycin resistance with twice-weekly treatment of HIV-related tuberculosis.
Am J Respir Crit Care Med, 173 (2006), pp. 350-356
[11.]
Updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors. MMWR Morb Mortal Wkly Rep. 2000;49:185–9.
[12.]
H. McIlleron, G. Meintjes, W.J. Burman, G. Maartens.
Complications of antiretroviral therapy in patients with tuberculosis: drug interactions, toxicity, and immune reconstitution inflammatory syndrome.
J Infect Dis, 196 (2007), pp. S63-S75
[13.]
S.S. Abdool Karim, K. Naidoo, A. Grobler, N. Padayatchi, C. Baxter, A. Gray, et al.
Timing of initiation of antiretroviral drugs during tuberculosis therapy.
N Engl J Med, 362 (2010), pp. 697-706
[14.]
G. Meintjes, S.D. Lawn, F. Scano, G. Maartens, M.A. French, W. Worodria, et al.
Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings.
Lancet Infect Dis, 8 (2008), pp. 516-523
[15.]
M. Müller, S. Wandel, R. Colebunders, S. Attia, H. Furrer, M. Egger, et al.
Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis.
Lancet Infect Dis, 10 (2010), pp. 251-261
[16.]
W.B. Park, P.G. Choe, J.H. Jo, S.H. Kim, J.H. Bang, H.B. Kim, et al.
Tuberculosis manifested by immune reconstitution inflammatory syndrome during HAART.
AIDS, 21 (2007), pp. 875-877
[17.]
Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations.
Centers for Disease Control and Prevention.
MMWR Recomm Rep, 47 (1998), pp. 1-58
[18.]
Centers for Disease Control and Prevention.
Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents.
MMWR Early Release, 58 (2009), pp. 1-206
[19.]
D.N. Rose.
Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis.
Ann Intern Med, 129 (1998), pp. 779-786
[20.]
F. Gordin, R.E. Chaisson, J.P. Matts, C. Miller, M. De Lourdes García, et al.
Rifampin and pyrazinamide vs isoniazid for prevention of tuberculosis in HIV-infected persons: an international randomized trial. Terry Beirn Community Programs for Clinical Research on AIDS, the Adult AIDS Clinical Trials Group, the Pan American Health Organization, and the Centers for Disease Control and Prevention Study Group.
JAMA, 283 (2000), pp. 1445-1450
[21.]
Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection--United States; 2003. MMWR Morb Mortal Wkly Rep. 2003;52:735–9.
[22.]
P. Muñoz, C. Rodríguez, E. Bouza.
Mycobacterium tuberculosis infection in recipients of solid organ transplants.
Clin Infect Dis, 40 (2005), pp. 581-587
[23.]
J. Torre-Cisneros, A. Doblas, J.M. Aguado, R. San Juan, M. Blanes, M. Montejo, et al.
Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort.
Clin Infect Dis, 48 (2009), pp. 1657-1665
[24.]
P. Muñoz, J. Palomo, R. Muñoz, M. Rodríguez-Creixéms, T. Peláez, E. Bouza.
Tuberculosis in heart transplant recipients.
Clin Infect Dis, 21 (1995), pp. 398-402
[25.]
European best practice guidelines for renal transplantation.
Section IV: Long-term management of the transplant recipient. IV.7.2. Late infections. Tuberculosis.
Nephrol Dial Transplant, 17 (2002), pp. 39-43
[26.]
J.M. Aguado, J. Torre-Cisneros, J. Fortún, N. Benito, Y. Meije, A. Doblas, et al.
Tuberculosis in solid-organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology.
Clin Infect Dis, 48 (2009), pp. 1276-1284
[27.]
H. Dunlop.
Infliximab (Remicade) and etanercept (Enbrel): serious infections and tuberculosis.
CMAJ, 171 (2004), pp. 992-993
[28.]
J. Keane, S. Gershon, R.P. Wise, E. Mirabile-Levens, J. Kasznica, W.D. Schwieterman, et al.
Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent.
N Engl J Med, 345 (2001), pp. 1098-1104
[29.]
K.L. Winthrop, J.N. Siegel.
Tuberculosis cases associated with infliximab and etanercept.
Clin Infect Dis, 39 (2004), pp. 1256-1257
[30.]
L. Carmona, J.J. Gómez-Reino, V. Rodríguez-Valverde, D. Montero, E. Pascual-Gómez, E.M. Mola, BIOBADASER Group, et al.
Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists.
Arthritis Rheum, 52 (2005), pp. 1766-1772
[31.]
V. Rodríguez-Valverde, R. Cáliz, J.M. Álvaro-Gracia, J.L. Marenco de la Fuente, J. Mulero, J. Tornero, et al.
III Actualización del Consenso de la Sociedad Española de Reumatología sobre terapia biológica en la artritis reumatoide.
Reumatol Clin, 2 (2006), pp. S52-S59
[32.]
F. Bartalesi, S. Vicidomini, D. Goletti.
QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases.
Eur Respir J, 33 (2009), pp. 586-593
[33.]
A. Lalvani, K.A. Millington.
Screening for tuberculosis infection prior to initiation of anti-TNF therapy.
Autoimmun Rev, 8 (2008), pp. 147-152
[34.]
B.J. Marais, R.P. Gie, H.S. Schaaf, N. Beyers, P.R. Donald, J.R. Starke.
Childhood pulmonary tuberculosis: old wisdom and new challenges.
Am J Respir Crit Care Med, 173 (2006), pp. 1078-1090
[35.]
H.S. Schaaf, B.J. Marais, A. Whitelaw, A.C. Hesseling, B. Eley, G.D. Hussey, et al.
Cultureconfirmed childhood tuberculosis in Cape Town, South Africa: a review of 596 cases.
BMC Infect Dis, 7 (2007), pp. 140
[36.]
B.J. Marais, C.C. Obihara, R.P. Gie, H.S. Schaaf, A.C. Hesseling, C. Lombard, et al.
The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community.
Arch Dis Child, 90 (2005), pp. 1166-1170
[37.]
L. Rigouts.
Clinical practice: diagnosis of childhood tuberculosis.
Eur J Pediatr, 168 (2009), pp. 1285-1290
[38.]
M. Hatherill, T. Hawkridge, H.J. Zar, A. Whitelaw, M. Tameris, L. Workman, et al.
Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?.
Arch Dis Child, 94 (2009), pp. 195-201
[39.]
S.M. Graham, H.M. Daley, A. Banerjee, F.M. Salaniponi, A.D. Harries.
Ethambutol in tuberculosis: time to reconsider?.
Arch Dis Child, 79 (1998), pp. 274-278
[40.]
S.M. Finnell, J.C. Christenson, S.M. Downs.
Latent tuberculosis infection in children: a call for revised treatment guidelines.
Pediatrics, 123 (2009), pp. 816-822
[41.]
R. Bindu, N.W. Schluger.
Tuberculosis and pregnancy.
Semin Respir Crit Care Med, 19 (1998), pp. 295-306
[42.]
V.K. Arora, R. Gupta.
Tuberculosis and pregnancy.
Ind J Tub, 50 (2003), pp. 13-16
[43.]
R. Figueroa-Damien, J.L. Arredondo-García.
Pregnancy and tuberculosis: influence of treatment on perinatal outcome.
Am J Perinatol, 15 (1998), pp. 303-306
[44.]
K. Miller, J.M. Miller Jr.
Tuberculosis in pregnancy: interactions, diagnosis, and management.
Clin Obstet Ginecol, 39 (1996), pp. 120-142
[45.]
E. Palacios, R. Dallman, M. Muñoz, R. Hurtado, K. Chalco, D. Guerra, et al.
Drug-resistant tuberculosis and pregnancy: treatment outcomes of 38 cases in Lima, Peru.
Clin Infect Dis, 48 (2009), pp. 1413-1419
[46.]
B.C. Brost, R.B. Newman.
The maternal and fetal effects of tuberculosis therapy.
Obstet Gynecol Clin North Am, 24 (1997), pp. 659-673
[47.]
D.E. Snider, K.E. Powell.
Should women taking antituberculosis drugs breast-feed?.
Arch Intern Med, 144 (1984), pp. 589-590
[48.]
T.T. Yoshikawa.
Tuberculosis and aging: a global health problem.
Clin Infect Dis, 33 (2001), pp. 1034-1039
[49.]
W.W. Stead.
Special problems in tuberculosis: tuberculosis in the elderly and in residential homes, correctional facilities, long-term care hospitals, mental hospitals, shelters for the homeless, and jails.
Clin Chest Med, 10 (1989), pp. 397-405
[50.]
W. Stead, J. Lofgren, E. Warren, C. Thomas.
Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes.
N Engl J Med, 312 (1985), pp. 1483-1487
[51.]
C. Pérez-Guzmán, M.H. Vargas, A. Torres-Cruz, H. Villarreal-Velarde.
Does aging midify pulmonary tuberculosis? A meta-analytical review.
Chest, 116 (1999), pp. 961-967
[52.]
T. Vasankari, K. Liippo, E. Tala.
Overt and cryptic miliary tuberculosis misdiagnosed until autopsy.
Scand J Infect Dis, 35 (2003), pp. 794-796
[53.]
R.B. Byrd, B.R. Horn, D.A. Solomon.
Toxic effects of isoniazid in tuberculosis chemoprophylaxis: role of biochemical monitoring in 1,000 patients.
JAMA, 241 (1978), pp. 1239-1241
[54.]
K. Chmura, E. Chan.
Tuberculosis in the elderly: keep a high index of suspicion.
J Respir Dis, 27 (2006), pp. 307-315
[55.]
J.N. Pande, S.P. Singh, G.C. Khilnani, S. Khilnani, R.K. Tandon.
Risk factors for hepatotoxicity from antituberculosis drugs: a case-control study.
Thorax, 51 (1996), pp. 132-136
[56.]
CDC.
Prevention and control of tuberculosis in facilities providing long-term care to the elderly. Recommendations of the advisory committee for elimination of tuberculosis.
MMWR, 39 (1990), pp. 7-20
[57.]
S. Chia, M. Karim, R.K. Elwood, J.M. Fitzgerald.
Risk of tuberculosis in dialysis patients: a population-based study.
Int J Tuberc Lung Dis, 2 (1998), pp. 989-991
[58.]
R.S. Malone, D.N. Fish, D.M. Spiegel, J.M. Childs, C.A. Peloquin.
The effect of hemodialysis on isoniazid, rifampin, pyrazinamide, and ethambutol.
Am J Respir Crit Care Med, 159 (1999), pp. 1580-1584
[59.]
H. Stass, D. Kubitza.
Pharmacokinetics and elimination of moxifloxacin after oral and intravenous administration in man.
J Antimicrob Chemother, 43 (1999), pp. 83-90
[60.]
M. Martínez-Lirola, N. Alonso-Rodríguez, M.L. Sánchez, M. Herranz, S. Andrés, T. Peñafiel, et al.
Advanced survey of tuberculosis transmission in a complex socioepidemiologic scenario with a high proportion of cases in immigrants.
Clin Infect Dis, 47 (2008), pp. 8-14
[61.]
O. Sanz-Peláez, J. Caminero-Luna, L. Pérez-Arellano.
Tuberculosis e inmigración en España. Evidencias y controversias.
Med Clin (Barc), 126 (2006), pp. 259-269
[62.]
U.R. Dahle, P. Sandven, E. Heldal, D.A. Caugant.
Continued low rates of transmission of Mycobacterium tuberculosis in Norway.
J Clin Microbiol, 41 (2003), pp. 2968-2973
[63.]
E. Geng, B. Kreiswirth, C. Driver, J. Li, J. Bruzynski, P. DellaLatta, et al.
Changes in the transmission of tuberculosis in New York City from 1900 to 1999.
N Engl J Med, 346 (2002), pp. 1453-1458
[64.]
M. Ravins, H. Bercovier, D. Chemtob, Y. Fishman, G. Rahav.
Molecular epidemiology of Mycobacterium tuberculosis infection in Israel.
J Clin Microbiol, 39 (2001), pp. 1175-1177
[65.]
S. Borrell, M. Español, A. Orcau, G. Tudó, F. March, J.A. Caylà, et al.
Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona.
Clin Microbiol Infect, (2009),
[66.]
S. Diz, R. López-Vélez, A. Moreno, J. Fortún, L. Moreno, E. Gómez-Manpaso, et al.
Epidemiology and clinical features of tuberculosis in immigrants at an infectious diseases department in Madrid.
Int J Tuberc Lung Dis, 11 (2007), pp. 769-774
[67.]
J.M. Ramos, M. Masiá, J.C. Rodríguez, I. Padilla, M.J. Soler, F. Gutiérrez.
Tuberculosis en inmigrantes: diferencias clínico-epidemiológicas con la población autóctona/1999–2002).
Enferm Infecc Microbiol Clin, 22 (2004), pp. 315-318
[68.]
P.L. Zuber, M.T. McKenna, N.J. Bibkin, I.M. Onorato, K.G. Castro.
Long-term risk of tuberculosis among foreign-born persons in the United States.
JAMA, 278 (1997), pp. 304-307
[69.]
K.P. Cain, C.A. Haley, L.R. Armstrong, K.N. Garman, C.D. Wells, M.F. Iademarco, et al.
Tuberculosis among foreign-born persons in the United States.
Am J Respir Crit Care Med, 175 (2007), pp. 75-79
[70.]
A. Arce Arnáez, J. Iñigo Martínez, L. Cabello Ballesteros, M. Burgoa Arenales.
Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994–2003.
Med Clin (Barc), 125 (2005), pp. 210-212
[71.]
The WHO/IUATLD Global Project on anti-tuberculosis drug resistance surveillance. Four Global Report. Available at: http://www.who.int/tb/publications/
[72.]
H. Huerga, R. López-Vélez, E. Navas, E. Gómez-Manpaso.
Clinicoepidemiological features of immigrants with tuberculosis living in Madrid, Spain.
Eur J Clin Microbiol Infect Dis, 19 (2000), pp. 236-237
[73.]
M. Tirado, R. Moreno, M. Marín, F. González, F. Pardo, A. García del Busto, et al.
Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995–2003.
Med Clin (Barc), 126 (2006), pp. 761-764
[74.]
J.A. Caylà, T. Rodrigo, J. Ruiz-Manzano, J.A. Caminero, R. Vidal, J.M. García, Working Group on Completion of Tuberculosis Treatment in Spain (Study ECUTTE), et al.
Tuberculosis treatment adherence and fatality in Spain.
Respir Res, 10 (2009), pp. 121
[75.]
L. Anibarro, S. Casas, J. Paz-Esquete, L. González, A. Pena, M. Guerra, et al.
and the Mycobacteria Study Group (GEIM) of Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC).Treatment completion in latent tuberculosis infection at specialist tuberculosis units in Spain.
Int J Tuberc Lung Dis, 14 (2010), pp. 701-707
[76.]
K. Dasgupta, D. Menzies.
Cost-effectiveness of tuberculosis control strategies among immigrants and refugees.
Eur Respir J, 25 (2005), pp. 1107-1116
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