The phenomenon of emerging tuberculosis in Italy. Which role for concurrent HIV infection?
Abstract number: 1134_04_258
Manfredi R., Sabbatani S., Chiodo F.
Tuberculosis (T) is borne by increasing morbidity-mortality rates, due to changes in its epidemiology, presentation, and spread of drug-resistant strains. The recent variation of predisposing factors (advancing age, concomitant illnesses, alcoholism and drug abuse, immigration from endemic regions, and HIV disease), play a significant role.
Methods and Results:
Among 98 consecutive patients (p) with confirmed T hospitalized since 1996, significant differences were found between the 63 Italian p, and the 35 p coming from outside of Western Europe. When compared with foreigners, Italian p had a higher frequency of HIV/AIDS (31.7% of Italian cases; p < 0.001), with a predominant pleuropulmonary involvement vs with lymph node and/or disseminated one among HIV-infected p vs non-HIV-infected ones (p < 0.01). Compared with foreigners, Italians showed a higher median age (p < 0.001), and more frequent and varied underlying disorders (personal-familial history of T, chronic pulmonary, heart, liver, or kidney disease, diabetes mellitus, malignancies, and collagen vascular disease treated wih steroids; p < 0.05), while immigrants had generic risk factors (low income, social-economic problems, cigarette smoke, and drug-alcohol use; p < 0.05 vs Italians). Our 8-year experience shows that 2 different patterns of T may be observed. Italian p are mostly represented by the elderly, with underlying diseases and specific risk factors for T, a more frequent HIV co-infection (and a more common involvement of sites other than pulmonary ones), while immigrants are represented by young, otherwise healthy p with predominant lung disease.
Physician awareness of T needs improvement, especially when high-risk p are of concern (like HIV-infected p), to ensure a rapid diagnosis and cure, and reduce T spread. The epidemiologic-clinical features of our T p show a significantly different pattern between Italians and immigrant, but we cannot exclude that the spread of T, the continued immigration, and growing predisposing conditions in the general population may lead to a further increase of diagnoses especially towards extreme life ages. Surveillance and preventive strategies of screening, diagnosis, therapy, and control of T need a continuous monitoring, to avoid further T spread, due to the merging of risk factors of immigrants, which is expected to represent a health care threaten in inner cities, where the progressive integration of immigrants may meet exposed and vulnerable natives, including elderly and HIV-infected p.
|Session name:||XXIst ISTH Congress|
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