4. Tuberculosis Diagnosis
• Latent TB granulomas can be seen on a chest
xray
• Mantoux skin test
http://www.cmaj.ca/content/169/9/937.full
http://www.health.state.mn.us/divs/idepc/di
seases/tb/tst.html
5. Tuberculosis Treatment
• Suggested treatment according
to the CDC includes:
o ACTIVE--
• isoniazid (INH)
• rifampin (RIF)
• ethambutol (EMB)
• pyrazinamide (PZA)
o LATENT--
isoniazid (INH)
6. Tuberculosis Prevalence
• Tuberculosis (TB) is one of the most important
infectious diseases in the world in terms of
morbidity and mortality
• In 2008, the number of deaths due to TB was
estimated at 1.8 million by the World Health
Organization (WHO)
• In 2008, an estimated 0.48 million new cases
occurred in South Africa and, currently, the country
ranks third after India and China in terms of total
number of annual incident cases of TB
15. Smoking increases the risk of relapse after
successful tuberculosis treatment
Batista, et al.--2008
16. Comparison of pulmonary and
extrapulmonary tuberculosis in Nepal- a
hospital-based retrospective study
Sreeramareddy, et al.--2008
•Smokers less likely to have isolated
extrapulmonary TB
• History of TB associated with pulmonary
TB
•No identification if this was a relapse
or reinfection
•Reinfection more common in high
burden countries
18. Smoking and risk of tuberculosis incidence,
mortality, and recurrence in South Korean
men and women
Jee, et al.--2009
19. Smoking and mortality from tuberculosis
and other diseases in India: retrospective
study of 43 000 adult male deaths and
35 000 controls
Gajalakshmi, et al.--2009
21. Tuberculosis and recurrence and its associated
risk factors among successfully treated patients
Millet, et al.--2009
22. Analysis of recent data collected by the
Barcelona Public Health Agency
• Data collected on 5,141 males and females living in
Barcelona
•SPSS used to calculate frequencies and percentages
for the following associations:
•OUTCOME and:
•sex, country of origin, diabetes status, alcohol,
homelessness, DOT therapy, imprisonment
status, HIV status, and smoking status
•SMOKING STATUS and:
• sex, country of origin, diabetes status, alcohol,
homelessness, DOT therapy, imprisonment
status, and HIV status
23.
24.
25. Legionnaires’ Disease
• Legionella pneumophila
• Low reporting rate
• Can be lethal
• Aerosol transmission
• Risk factors:
• Old age
• Smoking
• Chronic lung disease
• Immunosuppression
26. Legionnaires’ Diagnosis and
Treatment
• Diagnosis
• Chest x-ray
• Sputum culture
• Urinary antigen test
• Blood antibody test
• Treatment
• Antibiotics
http://www.wrongdiagnosis.com/phil/html/legionnaires-disease/192.html
29. Analysis of recent data collected by the
Barcelona Public Health Agency
• Data collected on 1,018 males and females living in
Barcelona
•SPSS used to calculate frequencies and percentages
for the following associations:
•OUTCOME and:
•sex, country of origin, diabetes status, alcohol,
cardiopulmonary disease, immunosuppressive
treatment and disease, renal transplant, cancer
status, and smoking status
•SMOKING STATUS and:
• sex, country of origin, diabetes status, alcohol,
cardiopulmonary disease, immunosuppressive
treatment and disease, renal transplant, cancer
status
30.
31. Acknowledgements
• Josep M. Antó, Carme Borrell, Joana Porcel and
CREAL staff
• Joan A. Caylà
• Angeles Orcau
• Cecilia Tortasada
• Lourdes Baezconde-Garbanati
• Kathleen Dwyer
• Daniel Soto and Camille Dennard
• Rosa Barahona
32. References
1. Tuberculosis (TB) (2009, June 1). In Center for Disease Control and Prevention. Retrieved July 11, 2011, from
http://www.cdc.gov/tb/topic/basics/default.htm
2. Associations between tobacco and tuberculosis. Chiang CY, Slama K, Enarson DA. International Union
Against Tuberculosis and Lung Disease, Paris, France. Int J Tuberc Lung Dis. 2007 Mar;11(3):258-62.
http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/17352089
3. Batista, J. L., Albuquerque, M. P., Ximenes, R. A., & Rodrigues, L. C. (2008, August). Smoking increases the risk of
relapse after successful tuberculosis treatment. Int J Epidemiol, 37(4), 841-851. doi:10.1093/ije/dyn113
4. Brunet, L., Pai, M., Davids, V., Ling, D., Paradis, G., Lenders, L., & Meldau, R. (2011, July). High prevalence of
smoking among patients with suspected tuberculosis in South Africa [Electronic version]. Eur Respir J., 38(1), 139-
146.
5. Kolappan, C., & Gopi, P. G. Tobacco smoking and pulmonary tuberculosis. Thorax, 57(11), 964-966. Retrieved from
PubMed (12403879).
6. Lavigne, M., Rocher, I., Steensma, C., & Brassard, P. (2006, March). The impact of smoking on adherence to
treatment for latent tuberculosis infection [Electronic version]. BMC Public Health., 6, 66.
7. Sreeramareddy, C. T., Panduru, K. V., Verma, S. C., Joshi, H. S., & Bates, M. N. (2008, January). Comparison of
pulmonary and extrapulmonary tuberculosis in Nepal-a hospital-based retrospective study. BMC Infect Dis., 8, 8.
doi:10.1186/1471-2334-8-8
8. Thomas, A., Gopi, P. G., Santha, T., Chandrasekaran, V., Subramani, R., Selvakumar, N., & Eusuff, S. I. (2005, May).
Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India
[Electronic version]. Int J Tuberc Lung Dis., 9(5), 556-561.
9. Gajalakshmi, V., Peto, R., Kanaka, T. S., & Jha, P. (2003, August 16). Smoking and mortality from tuberculosis and
other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls [Electronic version].
Lancet, 362(9383), 507-515.
10. Millet, J. P., Orcau, A., Garcia de Olalla, P., Casals, M., Rius, C., & Cayla, J. A. (2009). Tuberculosis recurrence and
its associated risk factors among successfully treated patients. J Epidemiol Community Health, 63, 799-804.
doi:10.1136/jech.2008.077560
11. Che, D., Campese, C., Santa-Olalla, P., Jacquier, G., Bitar, D., Bernillon, P., & Desenclos, J. C. (2008, December).
Sporadic community-acquired Legionnaires' disease in France: a 2-year national matched case-control study
[Electronic version]. Epidemiol Infect., 136(12), 1684-1690.
12. Patient Facts: Learn More about Legionnaires' disease. (2011, June). In Legionellosis Resource Site (Legionnaires'
Disease and Pontiac Fever). Retrieved July 14, 2011, from http://www.cdc.gov/legionella/patient_facts.htm
According to the CDC, tuberculosis is defined as a bacterial infection caused my mycobacterium tuberculosis. It often infects the lungs, but can be found in other parts of the body. Tuberculosis is spread through aerosol transmission when actions like sneezing or even breathing can send myscobacterium particles into the air to infect others. Individuals can have two types of tb infections- a latent infection is one in which a person is infected with tb, but does not show any signs or symptoms. The bacteria resides in places like the lungs surrounded by macrophages that wall off the bacteria from the rest of the body, causing what is called a granuloma.
latent tb granulomas show up on a chest xray as opaque areas and can be easily diagnosed this way. However, because xray radiation provides its own risk, the mantoux skin test can also be used. In this procedure a tiny solution containing tuberculin, a mycobacterium tuberculosis derivative, is injected under the skin on the forearm. If after 48-72 hours after the injection there is a indurated area that may or may not be erythematous. Usually if the skin test is positive, a chest xray is performed to to confirm the diagnosis and determine the severity.
active tb treatment includes a six to 12 month course of various antibiotics to rid mycobacterium tuberculosis from the body. latent tb on the other hand, requires treatment with isoniazid for 9 months.
This map represents worldwide prevalence of TB in 2009.
9.4 million worldwide with 2 million in India
We reviewed ten articles for this topic through various databases including pub med and google scholar. Based on the studies we found, here are some of the general trends…..
Smokers had very high TB mortality, as much as nine times those who had never smoked, but once they quit, the risk reduced substantially and was similar to those who never smoked. Smoking cessation has benefits to the smokers far beyond reducing TB risk, but successful tobacco control could favorably impact the TB mortality rate and reduce this public health burden, which has plagued the Taiwanese population. Smoking cessation could reduced nearly 1/3 of TB deaths.
This matched case control study, conducted among men in India, found this statistically significant dose response relationship with increasing number of cigarettes smoked per day.
We reviewed ten articles for this topic through various databases including pub med and google scholar. Based on the studies we found, here are some of the general trends…..
In Cape Town, smoking prevalence among 500 patients with suspected and confirmed TB was much higher than in general South African population
Because smoking in this population was high overall, no pattern could be seen between smoking and tuberculosis infection.
FOUND HOW SMOKING ADDITIONALLY AFFECTS TREATMENT, NOT JUST THE DISEASE COURSE ITSELF
Smoking prevalence 21%, the overall mean nicotine dependence among smokers was low 2.9/10 and reflected the fact that only 17% of current smokers reported being tobacco dependent.
Smokers smoked less than 12 cig per day which is less than 48% of the tuberculosis sample, while 23% smoked at least 25 cig per day.
Overall adequate adherence to LTBI treatment was found in 217 out of 302 participants
We reviewed ten articles for this topic through various databases including pub med and google scholar. Based on the studies we found, here are some of the general trends…..
In this prospective cohort study, newly diagnosed TB cases were assessed on many different risk factors and the only statistically significant association found for TB relapse was smoking– even after adjustment for other socioeconomic variables.
This retrospective cohort study assessed the prevalence of pulmonary and extrapulmonary TB in Nepal since studies like this one do not exist. The results found were….
We reviewed ten articles for this topic through various databases including pub med and google scholar. We also were able to search references of significant papers for relating studies. Based on the studies we found, here are some of the general trends…..
Model 1 adjusted for age and age squared
Model 2 adjusted for age, age squared, and BMI
14 year prospective cohort study in which the authors explored the association between smoking and tuberculosis incidence, recurrence, and mortality. Compared with never smokers, currents smokers had increased mortality from TB among men and women
This is a case control study done in India with the objective of assessing age specific mortality for smoking among men (since few women smoke here) in rural and urban areas. This table summarizes the results with tuberculosis clearly the most associated disease with smoking at 61%. Among urban and rural ever smokers the absolute excess mortality from TB was substantial throughout the age range from 25-69 years old.
We reviewed ten articles for this topic through various databases including pub med and google scholar. Based on the studies we found, here are some of the general trends…..
In this population based retrospective cohort study in Barcelona from 1995-2005 found statistically significant associations between the all variables analyzed and tuberculosis.
According to the CDC, legionnaires’ disease is caused by the bacteria legionella. The accurate incidence rates for this disease are suspected to be artificially low because numerous cases are never reported. 5-30% of cases can be lethal. Risk factors for this disease include old age, current or former smokers, immunosuppression and chronic lung disease.
We reviewed fivearticles for this topic through various databases including pub med and google scholar. Based on the studies we found, here are some of the general trends…..
In this matched prospective case control study done in France identified risk factors for Legionnaires’ disease. The results show a statistically significant association between current smoking and Legionnaires’ disease.
