Tuberculosis risk factors

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

Overview

The risk factors for the development of tuberculosis include: traveling or living in areas endemic for TB, immunosuppression (patients taking immunosuppressive medication or with immunosuppressive diseases, such as HIV or diabetes); history of contact with infected patients, bad hygiene conditions, and evidence of previous tuberculosis. Risk factors for multidrug-resistant TB include: non-adherence to treatment regimen, inadequate medication for that strain of bacteria, and contact with patients with multidrug-resistant TB.

Risk Factors

Primary TB disease (1-5% cases) occurs soon after infection, however, the majority of cases occur with latent infection, where there are no obvious symptoms. The dormant bacilli can cause tuberculosis in 2 to 23% of the latent cases, often many years after initial infection.[1] The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In patients co-infected with HIV, the risk of reactivation increases to 10% per year.

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

  • Traveling or living in endemic regions (Sub-saharan African, Russia, India, Pakistan, China)
  • Elderly
  • Infants
  • IV drug users
  • Immunosuppression:
  • Or those taking medications, such as:

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

  • Frequent contact with people who have TB
  • Poor nutrition
  • Smoking
  • Bad hygiene

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

  • 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 strains of TB

Drugs With Increased Risk of Tuberculosis Reactivation

  • Treatment with the following drugs have been reported with increased risk of reactivation of latent tuberculosis.

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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