High Rates of Tuberculosis in End-Stage Renal Failure: the Impact of International Migration

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Abstract

We studied a cohort of patients requiring renal dialysis who had migrated to the United Kingdom from tuberculosis (TB)-endemic countries and found extremely high rates of TB (1,187 cases per 100,000 per year), partly associated with end-stage diabetic renal disease. We recommend enhanced vigilance and screening of such patients, both to reduce illness and death and to prevent nosocomial spread of TB among susceptible persons.

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Neural tube defect surveillance and folic acid intervention--Texas-Mexico border, 1993-1998.

(2000)

Neural tube defects (NTDs) are common and serious malformations that originate early in pregnancy. In the United States, approximately 4000 pregnancies each year are affected by the two most common NTDs (spina bifida and anencephaly). In 1992, the Texas Department of Health (TDH), with support from a CDC cooperative agreement, implemented the Texas Neural Tube Defect Project (TNTDP), a program of NTD surveillance and risk-reduction activities in the 14 counties that border Mexico. The project was initiated in response to an anencephaly cluster identified during 1990-1991 in Brownsville (Cameron County), Texas (1). Whether the high anencephaly rate (19.7 per 10,000 live births) was unique to Cameron County or was characteristic of the entire border was unknown. This report summarizes NTD surveillance rates for the 14 Texas-Mexico border counties for 1993-1998 and presents preliminary results of TNTDP efforts to prevent the recurrence of NTDs by providing folic acid to high-risk women. Findings indicate that the baseline rate along the border is high (13.4 per 10,000 live births) and largely reflects the rate among Hispanics (13.8). Although a longer period is needed to obtain definitive results, folic acid appears to be effective for reducing the risk for NTD recurrence in Hispanics.

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The impact of comorbidity on mortality following in-hospital diagnosis of tuberculosis.

M Kollef, Gareth Fraser, E Iademarco … (1998)

Despite the availability of curative chemotherapy, mortality remains high among patients hospitalized for tuberculosis. Although the elevated mortality rate is often attributed to the presence of multidrug resistant tuberculosis (MDRTB) or concomitant infection with the HIV, other factors must be contributory, especially among the HIV-negative population. Therefore, we performed a study to define the factors associated with mortality following the in-hospital diagnosis of tuberculosis in a region with low levels of MDRTB and coinfection with HIV. Retrospective cohort study. The eight hospitals in the Barnes-Jewish-Christian (BJC) Health System, which is a network of community and tertiary-care level facilities serving the St. Louis, MO, metropolitan area. All 203 patients hospitalized with culture-positive tuberculosis at one of the BJC system hospitals between 1988 and 1996. Follow-up information was obtained by telephone interview and review of medical and public health records. Death was verified through a search of the death certificate registry of Missouri and the records of the Social Security Administration. Mortality was defined as death from any cause during the 14 months following the initial date of hospitalization. The cumulative all-cause mortality rate for this cohort was 28.1%. The incidence of HIV positivity was 7.9% and of MDRTB was 1.5%. Multiple logistic regression analysis demonstrated that respiratory failure requiring mechanical ventilation (adjusted odds ratio [AOR] = 6.5; 95% confidence interval [CI] = 6.0 to 7.0; p 60 years (AOR = 3.5; 95% CI = 2.4 to 5.2; p 7-day delay in the suspicion of the diagnosis of tuberculosis and the institution of antituberculosis therapy following hospital admission. There was no association between the presence of these delays and mortality. Our data suggest that the 14-month mortality rate is high among patients diagnosed as having tuberculosis during hospitalization, despite low incidences of HIV infection and multidrug resistant disease. The factors that appear to contribute to this elevated mortality rate are markers of disease chronicity and severity of not only the tuberculosis, but also of the patient's underlying health status. Thus, while HIV positivity and multidrug resistance can be important determinants of mortality in some populations, other demographic factors and comorbid conditions may play a role as well. These data also suggest that tuberculosis is often superimposed on chronic illnesses that are important determinants of patient outcomes.

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Risk of tuberculosis in dialysis patients: a population-based study.

S. Chia, A. S. M. Bazlul Karim, R K Elwood … (1998)

Provincial tuberculosis (TB) and dialysis registries. To document the risk of TB among patients on dialysis and to describe the clinical characteristics of these cases. All cases of TB occurring among dialysis patients in British Columbia between January 1990 and December 1994 were reviewed, as were the age-specific rates for TB among the general population during the same period. During that period, a total of seven cases of TB occurred among 560 patients on hemo-dialysis and two cases among 326 patients on peritoneal dialysis. On an annual basis the rate of TB in the dialysis population was 253 per 100,000, compared to an age-matched rate of 10.1 per 100,000 in the general population, giving a relative risk of 25.3 (95% confidence interval 22.86-31.49, P = 0.0000001). The risk of TB in dialysis patients is significantly higher than previously reported from non population-based studies, indicating that dialysis patients should be considered a possible target population for systematic evaluation for the presence of TB infection and consideration for chemoprophylaxis.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): January 2002

Volume: 8

Issue: 1

Pages: 77-78

Affiliations

[1]Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, United Kingdom

Author notes

Address for correspondence: Jon S. Friedland, Dept. of Infectious Diseases, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London W12 0NN, United Kingdom; fax: 44-208-383-3394; e-mail: j.friedland@ 123456ic.ac.uk

Article

Publisher ID: 01-0017

DOI: 10.3201/eid0801.010017

PMC ID: 2730270

PubMed ID: 11749753

SO-VID: 5bca42ec-fe7d-4ff3-92d3-ca658991fb0a

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High Rates of Tuberculosis in End-Stage Renal Failure: the Impact of International Migration

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Point-Of-Care Testing for Tuberculosis

Most cited references 11

Neural tube defect surveillance and folic acid intervention--Texas-Mexico border, 1993-1998.

The impact of comorbidity on mortality following in-hospital diagnosis of tuberculosis.

Risk of tuberculosis in dialysis patients: a population-based study.

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