title: Risk factors associated with pulmonary tuberculosis:  smoking, diabetes and anti-TNFα drugs.
abstract: OBJECTIVE
  Tuberculosis (TB) remains a global emergency and continues to kill 1.4 million people every year. The interaction between noncommunicable and infectious diseases like TB has important implications with regard to the attainment of the Millennium Development Goals (MDGs). Smoking, diabetes mellitus, anti-TNFα drugs and other immunosuppressive therapies are well known major risk factors associated with TB. The purpose of this review is to summarize the recent literature on these risk factors and interventions that reduce the risk.
  
  
  RESULTS
  Mathematical models and aggregate data from the field show that smoking, diabetes and anti-TNFα drugs independently increase the risk of developing active TB. There is consensus on the great need for screening for active TB disease in patients with these conditions and targeted preventive interventions through a combined multidisciplinary approach.
  
  
  CONCLUSIONS
  Smoking, diabetes mellitus, anti-TNFα drugs and new immunosuppressive treatments represent important common risk factors for TB. A high degree of clinical awareness of the possibility of TB should be considered in patients with these risk factors, and active screening and prevention should be undertaken. Further operational research is needed to optimize screening for latent Mycobacterium tuberculosis infection, instituting preventive intervention measures.
authors.affiliation: Lung Allergi Kliniken, Karolinska University Hospital, Stockholm, Sweden. giovanni.ferrara@karolinska.se
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrara
authors.forename: Megan
authors.initials: M
authors.lastname: Murray
authors.forename: Kevin
authors.initials: K
authors.lastname: Winthrop
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D048909:Diabetes Complications / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008403:Mass Screening; D009169:Mycobacterium tuberculosis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000503:physiopathology; D014397:Tuberculosis, Pulmonary / Q000209:etiology* / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects / Q000037:antagonists & inhibitors*
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha