Prevalencia de infección tuberculosa en las personas inmigrantes del área de salud de Toledo

The epidemiological transition has reduced infectious diseases mortality in most European countries, yet increased migrant influx risks importing diseases. All reported prevalence rates must be considered on a case-by-case basis depending on the disease in question, respective European Union (EU) country and migratory patterns at work. Tuberculosis has seen a re-emergence in Europe and is concentrated among migrants. Migrants arriving from North Africa (NA) and sub-Saharan Africa (SSA) carry higher rates of hepatitis C and B than the local EU population. The human immunodeficiency virus (HIV) impact of NA migrants to Europe is very low but a hallmark of the HIV epidemic is the penetration and circulation of non-B strains, recombinant forms and HIV-drug-resistant profiles through SSA migrants using NA as a transit point into Europe. Leishmaniasis is a re-emerging zoonotic disease prevalent to Southern Europe although not specifically isolated in migrant groups. Although not endemic in NA countries, malaria represent S: a risk in terms of re-emergence in Europe through transitory migrants arriving from SSA with the destination to Europe. Schistosomiasis has been largely eliminated from NA. High migrant flux into European countries has resulted in changing patterns of communicable disease and collectively requires a continuous surveillance. World Health Organization guidelines recommend targeted screening and preventative vaccination, followed by integration of migrants into the local health-care systems allowing for long-term treatment and follow-up. Finally, effective public health campaigns as a form of prevention are essential for the mitigation of disease dissemination in the migrant pool and for second-generation children of migrants.

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Baixa prevalência de PPD reativo prévia ao uso de infliximabe: estudo comparativo em população amostral do Hospital Geral de Fortaleza

Callado¹,

Lima²,

Nobre³

et al. 2011

Rev. Bras. Reumatol.

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Objective: To identify tuberculosis infection in rheumatic patients on infliximab by use of PPD testing prior to immunobiologic therapy. Methods: This study comprised 157 patients undergoing infliximab treatment and 734 other patients undergoing laboratory screening for tuberculosis infection originating from several services. The Mantoux technique was used for PPD testing, and an induration of at least 5 mm was considered reactive status. Results: In the infliximab group, 13% of the patients reacted to PPD, while, in the other group, 27% of the patients reacted to PPD (χ 2 = 13; P = 0.0003). These patients were divided into categories: adults with chronic diseases, PPD reactivity of 22%; and other controls, PPD reactivity of 31%. This shows the heterogeneous response of that population (χ 2 = 7; P < 0.009). In the infliximab group, subdivided according to pathologies [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA)], different reactivity rates were observed, the lowest value occurring among RA patients: (RA x AS: OR = 0.13; CI: 0.03-0.47; χ 2 = 12; P = 0.0004) and (RA x PA: OR = 0.16; CI: 0.02-1.04; χ 2 Yates corrected = 3.6; P = 0.05). The PPD reactivity in the RA subgroup (4%) was also lower as compared with that of the chronic patients group (22%) (OR = 0.16; CI: 0.05-0.49; χ 2 = 14; P = 0.0002), even when reclassified into four subgroups: rheumatology (OR = 0.19; CI: 0.04-0.72), kidney transplantation (OR = 0.16; CI: 0.05-0.51), infectology (OR = 0.21; CI: 0.05-0.75), and other conditions (OR = 0.13; CI: 0.04-0.44). Conclusion: The low prevalence of PPD reaction in this Brazilian population, mainly in chronic patients, with the worst performance among RA patients, shwoed that the test has limited value for diagnosis of tuberculosis infection in candidates to infliximab therapy.

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Prevalencia de infección tuberculosa en las personas inmigrantes del área de salud de Toledo

Cited by 8 publications

References 6 publications

Prevalencia de infección tuberculosa en las personas inmigrantes de Lorca (Murcia)

Prevalencia de infección tuberculosa en las personas inmigrantes de Lorca (Murcia)

Infectious diseases in North Africa and North African immigrants to Europe

Baixa prevalência de PPD reativo prévia ao uso de infliximabe: estudo comparativo em população amostral do Hospital Geral de Fortaleza

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