title: Impact of immigration on pulmonary tuberculosis in Spanish children: a three-decade review.
abstract: 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.
authors.affiliation: Microbiology Department, La Paz Hospital, Madrid, Spain. teredelrosal@yahoo.es
authors.forename: Teresa
authors.initials: T
authors.lastname: del Rosal
authors.forename: Fernando
authors.initials: F
authors.lastname: Baquero-Artigao
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: García-Miguel
authors.forename: Ana
authors.initials: A
authors.lastname: Méndez-Echevarría
authors.forename: Goosen
authors.initials: G
authors.lastname: López
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Aracil
authors.forename: María Isabel
authors.initials: MI
authors.lastname: de José
authors.forename: Fernando
authors.initials: F
authors.lastname: del Castillo
mesh_terms: 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
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid