TUBERCULOSIS IN TROPICAL AREAS AND IMMIGRANTS

Lorenzo Zammarchi, Filippo Bartalesi, Alessandro Bartoloni
  • Lorenzo Zammarchi
    Department of Critical Care Medicine and Surgery, Infectious Diseases Unit, University of Florence, Florence, Italy.,
  • Filippo Bartalesi
    Infectious and Tropical Diseases Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. bartalesif@aou-careggi.toscana.it,
  • Alessandro Bartoloni
    Alessandro Bartoloni, Infectious Diseases Unit, Department Surgery, University of Florence, Largo Brambilla 3, 50134 Florence, Italy 7949431. E-mail: bartoloni@unifi.it Competing interests: The authors have declare, Italy | bartoloni@unifi.it

Abstract

About 95% of cases and 98% of deaths due to tuberculosis (TB) occurs in tropical countries while in temperate low incidence countries, a disproportionate portion of TB cases is diagnosed in immigrants.

Urbanization, poverty, poor housing conditions and ventilation, poor nutritional status, low education level, the HIV co-epidemic, the growing impact of chronic conditions such as diabetes are the main determinants of the current TB epidemiology in tropical areas. TB care in these contests is complicated by several barriers such as geographical accessibility, educational, cultural, socio-psychological and gender issues. High quality microbiological and radiological facilities are not widely available and erratic supply of anti-TB drugs may affects tropical areas from time to time. Nevertheless in recent years, TB control programs reached major achievements in tropical countries as demonstrated by several indicators.

Migrants have an high risk of acquire TB before migration. Moreover, after migration, they are exposed to additional risk factors for acquiring new infection or reactivate it such as poverty, stressful living conditions, social inequalities, overcrowded housing, malnutrition, substance abuse, and limited access to health care. TB mass screening programs for migrants have been implemented in low endemic countries, but present several limitations. Screening programs should not represent a stand-alone intervention, but a component of a wider approach integrated with other healthcare activities to ensure the health of migrants.


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Submitted: 2014-07-21 14:05:51
Published: 2014-05-31 00:00:00
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