title: TB in a low-incidence country: differences between new immigrants, foreign-born residents and native residents.
abstract: BACKGROUND
  New immigrants and foreign-born residents add to the burden of pulmonary tuberculosis (TB) in low-incidence countries. The highest TB rates have been found among recent immigrants. Active screening programs are likely to change the clinical presentation of TB, but the extent of the difference between immigrant and resident populations has not been studied prospectively.
  
  
  METHODS
  Adult new immigrants were screened upon entry to 1 of 5 immigration centers in Switzerland. Immigrants with abnormal chest radiographs were enrolled and compared in a cohort study to consecutive admitted foreign-born residents from moderate-to-high incidence countries and native residents presenting with suspected TB.
  
  
  RESULTS
  Of 42,601 new immigrants screened, 112 had chest radiographs suspicious for TB. They were compared with foreign-born residents (n=118) and native residents (n=155) with suspected TB (n=385 patients included). Active TB was confirmed in 40.5% of all patients (immigrants 38.4%, foreign-born residents 50%, native residents 34.8%). Clinical signs and symptoms of TB and laboratory markers of inflammation were significantly less common in immigrants than in the other groups with normal results in >70%. The proportion of positive results on rapid testing to detect M. tuberculosis (MTB) in 3 respiratory specimens was significantly lower in immigrants (34.9% for acid-fast staining; 55.8% for polymerase chain reaction) compared with foreign-born residents (76.2% and 89.1%, respectively) and native residents (83.3% and 90.9%, respectively). Isoniazid resistance and multi-drug resistance were more prevalent in immigrants.
  
  
  CONCLUSIONS
  New immigrants with TB detected in a screening program are often asymptomatic and have a low yield of rapid diagnostic tests but are at higher risk for resistant MTB strains. Postmigration follow-up of pulmonary infiltrates is essential in order to control TB among immigrants, even in the absence of clinical and laboratory signs of infection.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland. laiferg@uhbs.ch
authors.forename: Gerd
authors.initials: G
authors.lastname: Laifer
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Mathew
authors.initials: M
authors.lastname: Simcock
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Ursula
authors.initials: U
authors.lastname: Fluckiger
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000995:Antitubercular Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D019083:Mediterranean Region / Q000453:epidemiology; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*
chemical_list: D000995:Antitubercular Agents