Impact of immigration on pulmonary tuberculosis in Spanish children: a three-decade review.
BACKGROUND
Tuberculosis causes significant morbidity and mortality worldwide. In the last years, international travel and immigration have led to important changes in the epidemiology of this disease. Drug resistance has emerged as an important threat to tuberculosis control. Data regarding the impact of immigration and the incidence of drug-resistant strains in children are lacking.


METHODS
Retrospective review of patients diagnosed with pulmonary tuberculosis at La Paz Children's Hospital in a 30-year period. Data were collected with regard to the clinical, radiologic, microbiologic, and demographic characteristics of patients, and data from the 3 decades of the study were compared using chi test and Fisher exact test.


RESULTS
A total of 507 cases of tuberculosis were identified, 414 of which had pulmonary involvement. During the study, there was a significant decrease in tuberculous meningitis: 10.4% in 1978-1987, 5.6% in 1988-1997, and 2.9% in 1998-2007 (P < 0.05). The most frequent reason for a consultation was case contact investigation. The adult source case was identified in 64% of patients. We observed an increase in extrafamilial contacts (8% in 1978-1987 and 18% in 1998-2007, P < 0.01), including 4 cases of immigrant caretakers. Tuberculosis in immigrant children has increased with time: 2% in the period 1978-1987, 6% in 1988-1997, and 46% in 1998-2007 (P < 0.001). The primary resistance rate to isoniazid in our population was 6.5%.


CONCLUSIONS
Tuberculosis in our area continues to be a major health problem, especially among foreign-born children. As drug-resistant strains are increasing, initial therapy with 4 drugs is recommended in our population.
del Rosal
Teresa
T
Microbiology Department, La Paz Hospital, Madrid, Spain. teredelrosal@yahoo.es
Baquero-Artigao
Fernando
F
García-Miguel
María Jesús
MJ
Méndez-Echevarría
Ana
A
López
Goosen
G
Aracil
Francisco Javier
FJ
de José
María Isabel
MI
del Castillo
Fernando
F
D000293:Adolescent; D000995:Antitubercular Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D024881:Drug Resistance, Bacterial; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014390:Tuberculosis, Meningeal / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology
D000995:Antitubercular Agents; D007538:Isoniazid