title: Tuberculosis and immigration in an area of southwest Madrid.
abstract: OBJECTIVE
  To describe differences between Spanish and immigrant tuberculosis (TB) cases.
  
  
  METHODS
  Retrospective descriptive study of Spanish and immigrant TB patients diagnosed in a Madrid hospital from 2004 to 2013.
  
  
  RESULTS
  A total of 322 patients were analysed, 183 Spanish-born and 139 immigrants (sub-Saharan Africa 32.4%, Morocco 28.8%, Latin America 20.1% and Eastern Europe 17.3%). Immigrants were younger and had a higher rate of human immunodeficiency virus (HIV) infection (P < 0.05). Spanish TB patients were often smokers and immunosuppressed (not HIV) (P < 0.001). No differences in symptoms and site of disease were detected. A higher proportion with isoniazid (INH) resistance was observed among immigrants (14.6% vs. 3.8%, P < 0.05), regardless of country of origin. Being an immigrant was an independent risk factor for INH resistance (OR 4.8, 95%CI 1.3-17.9).
  
  
  CONCLUSIONS
  There is currently no consensus on whether or not it would be appropriate to treat Spanish and immigrant patients with different regimens. Being an immigrant is a clear risk factor for INH resistance. According to our results, it is necessary to evaluate the impact of changing treatment protocols in Madrid, Spain. It is also important to introduce specific strategies for the management of TB among immigrants.
authors.affiliation: Internal Medicine Service, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Calderón Hernáiz
authors.affiliation: Internal Medicine Service, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Ruiz Giardín
authors.affiliation: Internal Medicine Service, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Cabello Clotet
authors.affiliation: Internal Medicine Service, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Canora Lebrato
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D000995:Antitubercular Agents / Q000627:therapeutic use; D054242:Emigrants and Immigrants; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid