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Smoking and Infectious Disease
Tuberculosis and Legionnaires'Disease
Sarah Pickett, Farva Jafri, and Souraya SourayanezhadUniversity of Southern California, MPH, 2011
Tuberculosis
• Mycobacterium Tuberculosis • Aerosol transmission• Latent vs. active tuberculosis
The association between smoking and tuberculosis has been investigated since 1918
Tuberculosis Diagnosis
• Latent TB granulomas can be seen on a chest xray
• Mantoux skin test
http://www.cmaj.ca/content/169/9/937.full
http://www.health.state.mn.us/divs/idepc/diseases/tb/tst.html
Tuberculosis Treatment
• Suggested treatment according to the CDC includes:
o ACTIVE-- •isoniazid (INH)•rifampin (RIF)•ethambutol (EMB)•pyrazinamide (PZA)
o LATENT-- isoniazid (INH)
Tuberculosis Prevalence
• Tuberculosis (TB) is one of the most important infectious diseases in the world in terms of morbidity and mortality
• In 2008, the number of deaths due to TB was estimated at 1.8 million by the World Health Organization (WHO)
• In 2008, an estimated 0.48 million new cases occurred in South Africa and, currently, the country ranks third after India and China in terms of total number of annual incident cases of TB
Active Tuberculosis
Studies Reviewed
The reduction of tuberculosis risks by smoking cessation
Wen, et al.--2010
Tobacco smoking and pulmonary tuberculosis
Kolappan, Gopi--2002
LatentTuberculosis
Studies Reviewed
High prevalence of smoking among patients with suspected tuberculosis in
South AfricaBurnet, et al.--2011
The impact of smoking on adherence to treatment for latent tuberculosis
infectionLavigne, et al.--2005
Relapse ofTuberculosis
Studies Reviewed
Smoking increases the risk of relapse after successful tuberculosis treatment
Batista, et al.--2008
Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a
hospital-based retrospective studySreeramareddy, et al.--2008
•Smokers less likely to have isolated extrapulmonary TB• History of TB associated with pulmonary TB•No identification if this was a relapse or reinfection•Reinfection more common in high burden countries
Mortality fromTuberculosis
Studies Reviewed
Smoking and risk of tuberculosis incidence, mortality, and recurrence in
South Korean men and womenJee, et al.--2009
Smoking and mortality from tuberculosis and other diseases in
India: retrospective study of 43 000 adult male deaths and 35 000 controls
Gajalakshmi, et al.--2009
Barcelona Tuberculosis
DataReviewed/ Analyzed
Tuberculosis and recurrence and its associated risk factors among successfully
treated patientsMillet, et al.--2009
Analysis of recent data collected by the Barcelona Public Health Agency
• Data collected on 5,141 males and females living in Barcelona•SPSS used to calculate frequencies and percentages for the following associations:•OUTCOME and:•sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, HIV status, and smoking status
•SMOKING STATUS and:• sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, and HIV status
Legionnaires’ Disease
• Legionella pneumophila• Low reporting rate• Can be lethal• Aerosol transmission• Risk factors:
• Old age• Smoking• Chronic lung disease• Immunosuppression
Legionnaires’ Diagnosis and Treatment
• Diagnosis• Chest x-ray• Sputum culture• Urinary antigen test• Blood antibody test
• Treatment• Antibiotics
http://www.wrongdiagnosis.com/phil/html/legionnaires-disease/192.html
Legionnaires’ Disease Data
Reviewed/ Analyzed
Sporadic community-acquired Legionnaires’ disease in France: a 2-year national matched case-control
studyChe, et al.--2008
Analysis of recent data collected by the Barcelona Public Health Agency
• Data collected on 1,018 males and females living in Barcelona•SPSS used to calculate frequencies and percentages for the following associations:•OUTCOME and:•sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status, and smoking status
•SMOKING STATUS and:• sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status
Acknowledgements
• Josep M. Antó, Carme Borrell, Joana Porcel and CREAL staff• Joan A. Caylà• Angeles Orcau• Cecilia Tortasada• Lourdes Baezconde-Garbanati• Kathleen Dwyer• Daniel Soto and Camille Dennard• Rosa Barahona
References1. Tuberculosis (TB) (2009, June 1). In Center for Disease Control and Prevention. Retrieved July 11, 2011, from
http://www.cdc.gov/tb/topic/basics/default.htm2. Associations between tobacco and tuberculosis. Chiang CY, Slama K, Enarson DA. International Union
Against Tuberculosis and Lung Disease, Paris, France. Int J Tuberc Lung Dis. 2007 Mar;11(3):258-62. http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/17352089
3. Batista, J. L., Albuquerque, M. P., Ximenes, R. A., & Rodrigues, L. C. (2008, August). Smoking increases the risk of relapse after successful tuberculosis treatment. Int J Epidemiol, 37(4), 841-851. doi:10.1093/ije/dyn113
4. Brunet, L., Pai, M., Davids, V., Ling, D., Paradis, G., Lenders, L., & Meldau, R. (2011, July). High prevalence of smoking among patients with suspected tuberculosis in South Africa [Electronic version]. Eur Respir J., 38(1), 139-146.
5. Kolappan, C., & Gopi, P. G. Tobacco smoking and pulmonary tuberculosis. Thorax, 57(11), 964-966. Retrieved from PubMed (12403879).
6. Lavigne, M., Rocher, I., Steensma, C., & Brassard, P. (2006, March). The impact of smoking on adherence to treatment for latent tuberculosis infection [Electronic version]. BMC Public Health., 6, 66.
7. Sreeramareddy, C. T., Panduru, K. V., Verma, S. C., Joshi, H. S., & Bates, M. N. (2008, January). Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a hospital-based retrospective study. BMC Infect Dis., 8, 8. doi:10.1186/1471-2334-8-8
8. Thomas, A., Gopi, P. G., Santha, T., Chandrasekaran, V., Subramani, R., Selvakumar, N., & Eusuff, S. I. (2005, May). Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India [Electronic version]. Int J Tuberc Lung Dis., 9(5), 556-561.
9. Gajalakshmi, V., Peto, R., Kanaka, T. S., & Jha, P. (2003, August 16). Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls [Electronic version]. Lancet, 362(9383), 507-515.
10. Millet, J. P., Orcau, A., Garcia de Olalla, P., Casals, M., Rius, C., & Cayla, J. A. (2009). Tuberculosis recurrence and its associated risk factors among successfully treated patients. J Epidemiol Community Health, 63, 799-804. doi:10.1136/jech.2008.077560
11. Che, D., Campese, C., Santa-Olalla, P., Jacquier, G., Bitar, D., Bernillon, P., & Desenclos, J. C. (2008, December). Sporadic community-acquired Legionnaires' disease in France: a 2-year national matched case-control study [Electronic version]. Epidemiol Infect., 136(12), 1684-1690.
12. Patient Facts: Learn More about Legionnaires' disease. (2011, June). In Legionellosis Resource Site (Legionnaires' Disease and Pontiac Fever). Retrieved July 14, 2011, from http://www.cdc.gov/legionella/patient_facts.htm
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