Black race, sex, and extrapulmonary tuberculosis risk: an observational study

Fiske, Christina T.; Griffin, Marie R.; Holt, Elizabeth; Warkentin, Jon; Lisa, Kaltenbach; Arbogast, Patrick G.; Sterling, Timothy R.

doi:10.1186/1471-2334-10-16

Cited by 57 publications

(52 citation statements)

References 23 publications

(27 reference statements)

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“…HIV infection and CVH did not associate with EPTB in our study, although in literature HIV seropositivity and liver cirrhosis are considered risk factors for EPTB [6,8,15]. This difference could be partly due to the lack of analysis on the severity of both diseases.…”

Section: Discussioncontrasting

confidence: 67%

“…A specific role of geographical origin in the occurrence of EPTB has already been suggested [3,5,6]. For example, Yang et al, found that American Indians and Asians/Pacific Islanders presented an increased risk for EPTB compared with non-Hispanic white subjects [8].…”

Section: Discussionmentioning

confidence: 95%

“…However, in Europe the proportion of EPTB cases increased from 16.4% in 2002 to 22.4% in 2011 and most of these were immigrants [4]. EPTB is reported to occur more often among women [4][5][6][7], HIV positive subjects [8] and immigrants [4,5,9]. Moreover, the site of EPTB reactivation seems to associate with the country or geographical area of origin, as shown by immigrants from Pakistan who were more susceptible to develop nodal TB [5].…”

Section: Introductionmentioning

confidence: 99%

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Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Nuzzo

Trentini

Grilli

et al. 2018

J Infect Dev Ctries

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Introduction: The constantly increasing immigration flows are influencing tuberculosis (TB) epidemiology in several European countries as well as in Italy. Extrapulmonary tuberculosis (EPTB) incidence rate is not decreasing and, among immigrants, it occurs in a remarkable number of cases. This study aimed to provide further insights regarding EPTB among natives and immigrants in a low TB burden and high immigrant receiving setting. Methodology: A total of 217 TB cases admitted to the University-Hospital of Ferrara from 2009 through 2015 were enrolled in the study. Clinical and demographical data including age, gender, origin, single comorbidities such as HIV status, chronic viral disease, chronic lung disease, diabetes, neoplasm, and multimorbidity were analyzed. Results: Of the 217 cases enrolled, 60.0% were immigrants and 40.0% natives, 68.7% presented pulmonary TB and 31.3% EPTB. By binary logistic regression, we observed that female gender (O.R. (95% C.I.): 1.95 (1.08-3.50), p < 0.05), Asian origin (5.70 (2.00-16.24), p < 0.001) and multimorbidity (6.42 (2.37-17.41), p < 0.001) were significantly associated to the development of EPTB compared to PTB. Nodal TB was the most common site of reactivation (56.5% among immigrants and 27.3% among natives). Conclusions: The data we found could be useful in increasing EPTB medical suspicion and decreasing EPTB diagnostic delay in low TB burden and high immigrant receiving settings.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Nuzzo

Trentini

Grilli

et al. 2018

J Infect Dev Ctries

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“…The global test was performed separately within each experimental condition and was controlled for white blood cell (WBC) count. We also controlled for the effect of race (black versus nonblack) because our previous epidemiologic work suggested that blacks were more likely to present with extrapulmonary TB (13). Also, persons of the black race have low numbers of WBCs and differences in monocyte function compared to persons of other races (6,35).…”

mentioning

confidence: 99%

Abnormal Immune Responses in Persons with Previous Extrapulmonary Tuberculosis in anIn VitroModel That SimulatesIn VivoInfection with Mycobacterium tuberculosis

Fiske

Almeida

Shintani

et al. 2012

Clin. Vaccine Immunol.

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T uberculosis (TB) presents an interesting paradox: while onethird of the world's population is infected with Mycobacterium tuberculosis, only 5 to 10% of those infected will develop active disease (1,23). This observation suggests that factors other than the mycobacterium play a role in the development of TB. Our understanding of protective immunity to M. tuberculosis infection is incomplete. The immune response to M. tuberculosis involves cells such as monocytes, macrophages, and T lymphocytes that produce cytokines such as CXCL8 (interleukin-8 [IL-8]), IL-12, gamma interferon (IFN-␥), and tumor necrosis alpha (TNF-␣) (16). While hematogenous dissemination occurs in most persons soon after infection, subsequent extrapulmonary TB disease does not (25). Development of extrapulmonary disease could be a result of a breakdown in host immune surveillance, a change in the mycobacteria from a dormant to an active state, or a combination of the two. Discovery of factors that predispose to extrapulmonary disease will advance TB prevention efforts by identifying immune responses that could be boosted by TB vaccines. It will also help identify individuals at increased risk for progression from latent infection to clinical disease, so that more intensive observation and treatment of latent infection can be initiated.Extrapulmonary TB is associated with underlying immune defects. For example, HIV-infected persons are at increased risk of extrapulmonary TB, and this risk increases as the CD4 ϩ T lymphocyte count declines (30). Young children also have an increased incidence of extrapulmonary TB, specifically TB meningitis, presumably due to an immature immune system (31). Our group has previously noted reduced peripheral blood mononuclear cell (PBMC) cytokine production and CD4 ϩ T lymphocytes in HIV-seronegative adults with previous extrapulmonary TB compared to persons with previous pulmonary TB or latent M. tuberculosis infection (2, 38). In a subset of patients from the present study, we also found that persons with previous extrapulmonary TB had increased regulatory T cell frequency and CD4 ϩ lymphocyte activation, indicating possible immune dysregulation (8). However, an evaluation of the sequential activation of innate and adaptive immune responses to M. tuberculosis infection in such patients has not been performed. We therefore assessed in vitro immune responses in persons with previous extrapulmonary TB under several experimental conditions, including one in which autologous monocyte-depleted PBMCs were cocultured with M. tuberculosis-infected host macrophages.

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“…While pulmonary tuberculosis can often be reliably diagnosed with imaging and sputum analysis, extra-pulmonary disease may often remain obscure. Tuberculosis lymphadenitis is now the most common extra-pulmonary manifestation of tuberculosis in both HIV positive and negative individuals in the USA (Fiske et al 2010;Heller et al 2010) Isolated abdominal lymphadenopathy especially presents a diagnostic challenge in HIV-infected patients. The dysfunctional immune response in HIV may obscure signs of infection which may lead to atypical clinical presentations (Bos et al 2013;Sinkala et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Polymerase Chain Reaction Amplifying Mycobacterial DNA from Aspirates Obtained by Endoscopic Ultrasound Allows Accurate Diagnosis of Mycobacterial Disease in HIV-Positive Patients with Abdominal Lymphadenopathy

Nieuwoudt¹,

Lameris²,

Corcoran³

et al. 2014

Ultrasound in Medicine & Biology

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Abdominal lymphadopathy in Human Immunodeficiency Virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study recruiting thirty-one symptomatic HIV+ patients with abdominal lymphadenopathy assessing diagnostic yield of endoscopic ultrasound (EUS) fine needle aspiration (FNA). Mean age was 38 years, 52% were female, mean CD4 count and viral load were 124 cells/pl, and 4 log respectively. EUS confirmed additional mediastinal nodes in 26 %. Porta-hepatis was the most common abdominal site. EUS FNA was subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7% and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity whereas PCR identified 90% of mycobacterial infections. Combining appearance of EUS FNA and cytology a diagnostic algorithm was developed to indicate when analysis with PCR would be useful. PCR performed on an EUS guided aspirate was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.

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Black race, sex, and extrapulmonary tuberculosis risk: an observational study

Cited by 57 publications

References 23 publications

Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Abnormal Immune Responses in Persons with Previous Extrapulmonary Tuberculosis in anIn VitroModel That SimulatesIn VivoInfection with Mycobacterium tuberculosis

Polymerase Chain Reaction Amplifying Mycobacterial DNA from Aspirates Obtained by Endoscopic Ultrasound Allows Accurate Diagnosis of Mycobacterial Disease in HIV-Positive Patients with Abdominal Lymphadenopathy

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