Critical Care: Global Case Report Poster - Miscellaneous |

Impact of Active TB Case Finding in a Population Resident in an Area of Northern Italy FREE TO VIEW

Alessandro Mastinu, MDS; Tiziana Stobbione, PhD; Daniela Rivetti, MD; Maurizio Oddone, MDS; Michela Terreno, MDS; Piercarlo Giamesio, MDS
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ASL AT Asti, Cardinal Massaia Hospital, Asti, Italy

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):279A. doi:10.1016/j.chest.2016.08.292
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SESSION TITLE: Global Case Report Poster - Miscellaneous

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Historically, human migration had a significant impact on the spread of tuberculosis (TB). Since the late 1980s, trans-mediterranean migration has reached an unprecedent entity in term of displaced persons and deep impact on social, cultural and health context in countries target of migrations. For exemple in Italy arrived, in only the first half of 2015, about 66,462 foreigners. This led to a necessary re-adaptation of the migrants monitoring and active case finding of tuberculosis systems in the immigrant population to preventing the disease spread in resident population. In the Piedmont region in the same period were 3584 migrants distributed in eight provinces. In our territorial local health organization of Asti (which has a catchment area of about 214,000 people), the hosted migrants are currently 607.

CASE PRESENTATION: As of the end of 2014 the new comers were subjected to a chest X-ray screening, according to the provisions the regional health authorities. Underwent chest X-ray 257 subjects with mean age of 25,9 years (range 16-48 years) received in our territory between October 2014 and January 2016. The 95,3% are male, 18.3% coming from Asia (Pakistan, Afghanistan, Bangladesh), while 81,7% from sub-Saharan Africa (o, which 79,4% from the countries bordering the Gulf of Guinea and the remaining 2,3% from the Africa's Horn). We founded 53 altered radiograms: 12 suggesting basal pleural consolidated outcomes, 21 with apical pleural thickening, 5 with basal inflammatory thickening, 1 with pulmonary excavated condensation of the upper left lobe that was later diagnosed as pulmonary tuberculosis M. tuberculosis positive; the remaining X-rays showed no abnormalities consistent with TB disease. The epidemiological survey conducted on confirmed case of pulmonary tuberculosis highlighted nine close contacts (that came from the same country and lived in the same reception center) who underwent immunological diagnostic TIGRA with Quantiferon TB Gold method. All subjects were positive with values between 0.55 and 9.54 (cut off 0.55), but the respective thoracic radiograms showed no signs of disease. The 9 subjects were diagnosed as latent TB and subjected to anti-tuberculosis prophylaxis with isoniazid 300 mg daily for six months. They were also subjected to immunoassay all other subjects with radiological abnormalities consistent with TB and none of them tested positive. The patient suffering from pulmonary tuberculosis was subjected to specific treatment for six months with isoniazid 300 mg daily, pyrazinamide 500 mg 3 times a day, rifampicin 450 mg twice a day; during the first two months was also administered ethambutol 400 mg three times a day. The patient has completed treatment and he is currently free from the disease in a five months follow-up.

DISCUSSION: This is definitely a limited series of cases, but it is the entire real picture of our health area. The migrants’ active screening provided accordig to regional health rules, allowed an immediate diagnosis of active TB disease and conditioned the start of a rapid prophylaxis in close contact to the index case. In the 13 months of surveillance they have not been diagnosed more cases of tuberculosis disease in the surveilled population.

CONCLUSIONS: The impact of active surveillance would seem to highlight the efficient control of the spread of the disease, with a positive impact on the health status of the resident population, in an area where tuberculosis is endemic with a prevalence of approximately 6.7 cases per 100,000 inhabitants. Active surveillance of migrants seems to be, therefore, a valuable tool to be implemented in monitoring the spread of imported diseases in the migrant population.

Reference #1: WHO: EUROTB Fact Sheet, 2007. EUR/TB/FS07 3 September 2007. http://www.euro.who.int/__data/assets/pdf_file/0019/69022/fs07E_TBmigration.pdf (Access on 01/04/2016)

Reference #2: Bruno Abarca Tomás, Christopher Pell, Aurora Bueno Cavanillas, José Guillén Solvas, Robert Pool, María Roura Tuberculosis in Migrant Populations. A Systematic Review of the Qualitative Literature Published: December 5, 2013 http://dx.doi.org/10.1371/journal.pone.0082440

Reference #3: Odone A, Tillmann T, Sandgren A, et al. Tuberculosis among migrant populations in the European Union and the European Economic Area. The European Journal of Public Health. 2015;25(3):506-512. doi:10.1093/eurpub/cku208.

DISCLOSURE: The following authors have nothing to disclose: Alessandro Mastinu, Tiziana Stobbione, Daniela Rivetti, Maurizio Oddone, Michela Terreno, Piercarlo Giamesio

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