Epidemiology and clinical features of tuberculosis in immigrants at an infectious diseases department in Madrid.

OBJECTIVE

To perform a comparative analysis of tuberculous immigrants and native-born subjects at a tertiary centre in Madrid, Spain, from January 1990 to December 2002.

RESULTS

The annual incidence of tuberculosis (TB) decreased from 141 in 1990 to 73 in 2002 despite an increase among immigrants (from 1% in 1990 to 27% in 2002), with 98 cases of TB among 1353 immigrants (overall rate 7.2%). The mean age was 30 years (6-77) and 54% were male. Most patients were from Latin America (55%) and Africa (37%). TB was diagnosed within 2 years of arrival in 69%. When performed, purified protein derivative test was positive in 88%. Human immunodeficiency virus co-infection was present in 6% vs. 37% among the native-born (P < 0.001). Pulmonary TB was the most frequent form in both groups (79% and 80%), with no differences in rates of sputum positivity (70% vs. 75%). Primary drug resistance was significantly higher among immigrants (13% vs. <6% among the native-born, P < 0.05). Initial four-drug regimens were followed by all immigrants. Overall, 82% of the patients were cured, one died due to disseminated disease (1%), and follow-up data were incomplete in 17 (17%).

CONCLUSION

TB among immigrants was clinically similar, but was not related to the common risk factors observed in native-born subjects. Given the higher prevalence of primary resistance in this population, initial four-drug regimens should be prescribed until susceptibility results are available.