Tuberculosis risk factors: Difference between revisions

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__NOTOC__
{{Tuberculosis}}
{{Tuberculosis}}
{{CMG}}; '''Assistant Editor-in-Chief:''' Somal Khan
{{CMG}}; {{AE}} {{Mashal Awais}}; {{JS}}


==Overview==
==Overview==
Tuberculosis, or TB is a bacterial infection that kills 3 million people worldwide, more people than any other infection in the world. Approximately one-third of the world is infected, and 15 million people in the US. Active tuberculosis kills 60% of the time if not treated, but treatment cures 90% of patients. Most people are infected with TB have latent TB. This means that the bacteria is controlled by the body's immune system. People with latent TB do not have symptoms and cannot transmit TB to other people. However, later if the infected person has a weakened immune system (AIDS, young children, elderly, sick with other diseases, etc.), the bacteria can break out leading to active TB, or TB disease.
The [[risk factor]]s for developing [[tuberculosis]] include:  living or traveling to [[Endemic (epidemiology)|endemic]] areas for TB, elderly people and infants, [[immunosuppression]], history of frequent or prolonged contact with [[infected]] patients, IV drug users, [[smoking]], bad [[hygiene]], and poor [[nutrition]]. In addition, the [[Risk factor|risk factors]] for [[multidrug-resistant TB]] include: [[non-adherence]] to [[treatment]] [[regimen]], inadequate [[treatment]] for that [[Bacteria|bacterial]] [[strain]], and [[Contact dermatitis|contact]] with patients with [[multidrug-resistant TB]].
==Risk factors==
Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and begin to multiply. In primary TB disease&mdash;1 to 5% of cases&mdash;this occurs soon after infection. However, in the majority of cases, a latent infection occurs that has no obvious symptoms. These dormant bacilli can produce tuberculosis in 2 to 23% of these latent cases, often many years after infection.<ref name=Parrish_1998>{{cite journal |author=Parrish N, Dick J, Bishai W |title=Mechanisms of latency in Mycobacterium tuberculosis |journal=Trends Microbiol |volume=6 |issue=3 |pages=107-12 |year=1998 | pmid = 9582936}}</ref> The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In patients co-infected with ''M. tuberculosis'' and HIV, the risk of reactivation increases to 10% per year.


Other conditions that increase risk include drug injection, mainly due to the lifestyle of 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; [[diabetes mellitus]]; [[silicosis]]; prolonged [[corticosteroid]] therapy and other immunosuppressive therapy; head and neck cancers; [[hematology|hematologic]] and [[Reticuloendothelial system|reticuloendothelial]] diseases, such as [[leukemia]] and [[Hodgkin's lymphoma|Hodgkin's disease;]] end-stage kidney disease; intestinal bypass or [[gastrectomy]]; chronic [[malabsorption]] syndromes; or low body weight.
==Risk Factors==
Primary [[TB]], which represents 1-5% cases, occurs after [[infection]]. However, most of the cases occur with latent [[infection]] which is [[asymptomatic]]. The [[dormant]] [[bacilli]] can cause [[tuberculosis]] in 2 to 23% of the latent cases, usually several years following the primary [[infection]].<ref name="Parrish_1998">{{cite journal |author=Parrish N, Dick J, Bishai W |title=Mechanisms of latency in Mycobacterium tuberculosis |journal=Trends Microbiol |volume=6 |issue=3 |pages=107-12 |year=1998 | pmid = 9582936}}</ref> The risk of [[reactivation]] is much higher with [[immunosuppression]], such as [[HIV]]. In patients with [[HIV]] coinfection, the risk of [[reactivation]] increases reaching up to 10% per year.


[[Twin study|Twin studies]] in the 1950's showed that the course of TB infection was highly dependent on the genetics of the patient. At that time, it was rare that one identical twin would die and the other live.<ref>New Scientist, 16 June 2007 [http://www.newscientist.com/article/mg19426086.100-this-week-50-years-ago.html]</ref>
''The following are [[Risk factor|risk factors]] for active [[TB]]:''<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref><ref name="Griffith_1996">{{cite journal |author=Griffith D, Kerr C |title=Tuberculosis: disease of the past, disease of the present |journal=J Perianesth Nurs |volume=11 |issue=4 |pages=240-5 |year=1996 | pmid = 8964016}}</ref>


Some drugs, including [[rheumatoid arthritis]] drugs that work by blocking [[tumor necrosis factor-alpha]] (an inflammation-causing [[cytokine]]), raise the risk of activating a latent infection due to the importance of this cytokine in the immune defense against TB.<ref name=Mutlu_2006>{{cite journal |author=Mutlu G, Mutlu E, Bellmeyer A, Rubinstein I |title=Pulmonary adverse events of anti-tumor necrosis factor-alpha antibody therapy |journal=Am J Med |volume=119 |issue=8 |pages=639-46 |year=2006 | pmid = 16887405}}</ref>
*Living or traveling to [[Endemic (epidemiology)|endemic]] areas (Sub-saharan African, Russia, India, Pakistan, China)
*[[Old age|Elderly]]
*[[Infant|Infants]]
*[[IV drug users]]
*[[Immunosuppression]]:
 
:*[[AIDS]]
:*[[Diabetes]]
:*[[Silicosis]]
:*[[Malignancy]], such as head and neck [[Cancer|cancers]]
 
*[[hematology|Hematologic]] and [[Reticuloendothelial system|reticuloendothelial]] disease, such as [[leukemia]] and [[Hodgkin's disease]]
 
:*[[End-stage kidney disease]]
:*History of [[gastrectomy]]
:*[[Malabsorption syndrome]]
 
*Or those taking medications, such as:
 
:*[[Chemotherapy]]
:*[[Immunosuppressive]] medications, such as prolonged [[corticosteroid]] therapy, [[tumor necrosis factor-alpha]] blockers<ref name="Mutlu_2006">{{cite journal |author=Mutlu G, Mutlu E, Bellmeyer A, Rubinstein I |title=Pulmonary adverse events of anti-tumor necrosis factor-alpha antibody therapy |journal=Am J Med |volume=119 |issue=8 |pages=639-46 |year=2006 | pmid = 16887405}}</ref>
:*[[Tocilizumab]]
 
''The risk of contracting [[TB]] increases in cases where there is:''<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
 
*Frequent or prolonged contact with people who have [[TB]]
*Poor [[nutrition]]
*[[Smoking]]
*Bad hygiene
 
The following factors may increase the rate of [[TB]] [[infection]] in a population:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
 
*[[Chest X-ray]] with evidence of previous [[TB]] disease (fibrotic lesions and nodules)
*Increased number of [[HIV]] infections
*Increased number of [[homeless]] people
*The appearance of [[drug-resistant]] [[Strain (biology)|strains]] of [[TB]]
 
==Drugs With Increased Risk of Tuberculosis Reactivation==
 
*Treatment with the following [[:Category:Drugs|drugs]] have been reported with increased risk of reactivation of [[latent tuberculosis]].
 
:*[[Adalimumab]]
:*[[Alemtuzumab]]
:*[[Belatacept]]
:*[[Certolizumab pegol]]
:*[[Canakinumab]]
:*[[Etanercept]]
:*[[Fluocortolone]]
:*[[Golimumab]]
:*[[Infliximab]]
:*[[Rilonacept]]
:*[[Ruxolitinib]]
:*[[Saxagliptin]]
:*[[Teriflunomide]]
:*[[Tocilizumab]]
:*[[Tofacitinib]]
:*Vedolizumab
 
===Multidrug-Resistant Tuberculosis===
[[Drug resistance]] is more common in people who:<ref name="WHO">{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref>
 
*Do not take their [[TB]] medicine regularly
*Do not take all of their [[TB]] medicine as told by their doctor or nurse
*Develop [[TB]] disease again, after having taken [[TB]] medicine in the past
*Come from areas of the world where [[drug-resistant]] [[TB]] is common
*Have spent time with someone known to have [[drug-resistant]] [[TB]] disease


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 06:35, 22 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; João André Alves Silva, M.D. [3]

Overview

The risk factors for developing tuberculosis include: living or traveling to endemic areas for TB, elderly people and infants, immunosuppression, history of frequent or prolonged contact with infected patients, IV drug users, smoking, bad hygiene, and poor nutrition. In addition, the risk factors for multidrug-resistant TB include: non-adherence to treatment regimen, inadequate treatment for that bacterial strain, and contact with patients with multidrug-resistant TB.

Risk Factors

Primary TB, which represents 1-5% cases, occurs after infection. However, most of the cases occur with latent infection which is asymptomatic. The dormant bacilli can cause tuberculosis in 2 to 23% of the latent cases, usually several years following the primary infection.[1] The risk of reactivation is much higher with immunosuppression, such as HIV. In patients with HIV coinfection, the risk of reactivation increases reaching up to 10% per year.

The following are risk factors for active TB:[2][3]

  • Or those taking medications, such as:

The risk of contracting TB increases in cases where there is:[2]

The following factors may increase the rate of TB infection in a population:[2]

Drugs With Increased Risk of Tuberculosis Reactivation

Multidrug-Resistant Tuberculosis

Drug resistance is more common in people who:[5]

  • Do not take their TB medicine regularly
  • Do not take all of their TB medicine as told by their doctor or nurse
  • Develop TB disease again, after having taken TB medicine in the past
  • Come from areas of the world where drug-resistant TB is common
  • Have spent time with someone known to have drug-resistant TB disease

References

  1. ↑ Parrish N, Dick J, Bishai W (1998). "Mechanisms of latency in Mycobacterium tuberculosis". Trends Microbiol. 6 (3): 107–12. PMID 9582936.
  2. ↑ 2.0 2.1 2.2 "Tuberculosis Fact Sheet".
  3. ↑ Griffith D, Kerr C (1996). "Tuberculosis: disease of the past, disease of the present". J Perianesth Nurs. 11 (4): 240–5. PMID 8964016.
  4. ↑ Mutlu G, Mutlu E, Bellmeyer A, Rubinstein I (2006). "Pulmonary adverse events of anti-tumor necrosis factor-alpha antibody therapy". Am J Med. 119 (8): 639–46. PMID 16887405.
  5. ↑ "Multidrug-resistant tuberculosis".

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