Chest Infections |

Nonpulmonary TB Epidemiology: 1993 Through 2010 FREE TO VIEW

Marc Valley, MD; Haytham Adada, MD; Souheil Abdel Nour, MD; Jayant Mehta, MD; D. Robbins, MD; Thomas Roy, MD
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East Tennessee State University, Johnson City, TN

Chest. 2013;144(4_MeetingAbstracts):268A. doi:10.1378/chest.1705172
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: Introduction of tuberculosis (TB) chemotherapy in the early 1950’s produced a logarithmic decrease in the incidence of TB in the US. The only exception was between 1985 and 1992. Contemporaneous research suggested that the increase in TB, especially non-pulmonary TB (NPTB), was due to the immune suppression found in patients within the epidemic of HIV. The purpose of this study is to analyze the epidemiology of NPTB and suggest potential causes for these findings

METHODS: Epidemiological data obtained from the CDC TB Surveillance Program from 1953 through 2011 was analyzed using appropriate linear regression, t-Test and Chi-Squared statistical methods. NPTB cases were analyzed from 1977 through 2011. TB cases with HIV status were analyzed from 1993 to 2010. Results are reported with (95% CI)

RESULTS: Although the number of NPTB cases did not change over the years (mean 3,169, 2089-4248), NPTB, as a percentage of total TB cases, rose from 14.57% in 1977-1981 to 20.99% in 2007-2010 (p=4.67x10-6). The percentage of NPTB in HIV + patients over 45 increased from 21.29% in 1993-1997 to 36.13% in 2008-2010. The percentage of NPTB in foreign born patients rose from 29.49% in 1993 to 60.10% in 2010 paralleled with an increase of PTB in foreign born patients. Of interest, while there was a shift to the 45+ age group for total TB Cases in foreign-born, there was no shift in the age distribution of foreign-born NPTB. There was no significant change of TB cases from high risk countries between 1993 and 2010, with exception of Mexico in 2004

CONCLUSIONS: The period 1985 through 1992 resulted in the reversal of the steadily decreasing trend in reported TB cases. It is difficult to assess HIV impact on NPTB rates and on the NPTB rates in foreign born patients in the early portion of the HIV epidemic due to unavailable data. The stable ratio of PTB to NPTB in HIV+ patients during the period of progressively more effective HIV treatment suggests that, if there is a predisposition for NPTB in HIV+ patients, it is not due to total viral load or measurable immune status. Use of anti-inflammatory drugs (anti-TNF) also contributes to the risk of extrapulmonary TB. The increase in NPTB in foreign born patients suggests that this source is becoming predominant

CLINICAL IMPLICATIONS: In the post-antiretroviral era, NPTB percentage of the total TB infections has increased. Foreign born patients appear to be at higher risk for NPTB.

DISCLOSURE: The following authors have nothing to disclose: Marc Valley, Haytham Adada, Souheil Abdel Nour, Jayant Mehta, D. Robbins, Thomas Roy

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