Smoking and Infectious Disease

Tuberculosis and Legionnaires'Disease

Sarah Pickett, Farva Jafri, and Souraya SourayanezhadUniversity of Southern California, MPH, 2011

Tuberculosis 

• Mycobacterium Tuberculosis •  Aerosol transmission• Latent vs. active tuberculosis

The association between smoking and tuberculosis has been investigated since 1918 

Tuberculosis Diagnosis 

• Latent TB granulomas can be seen on a chest xray

•  Mantoux skin test

http://www.cmaj.ca/content/169/9/937.full

http://www.health.state.mn.us/divs/idepc/diseases/tb/tst.html

Tuberculosis Treatment

• Suggested treatment according to the CDC includes:

o ACTIVE-- •isoniazid (INH)•rifampin (RIF)•ethambutol (EMB)•pyrazinamide (PZA)

o LATENT-- isoniazid (INH)

Tuberculosis Prevalence

• Tuberculosis (TB) is one of the most important infectious diseases in the world in terms of morbidity and mortality

• In 2008, the number of deaths due to TB was estimated at 1.8 million by the World Health Organization (WHO) 

• In 2008, an estimated 0.48 million new cases occurred in South Africa and, currently, the country ranks third after India and China in terms of total number of annual incident cases of TB

 

Active Tuberculosis

Studies Reviewed

The reduction of tuberculosis risks by smoking cessation

Wen, et al.--2010

Tobacco smoking and pulmonary tuberculosis

Kolappan, Gopi--2002

 

LatentTuberculosis

Studies Reviewed

High prevalence of smoking among patients with suspected tuberculosis in

South AfricaBurnet, et al.--2011

The impact of smoking on adherence to treatment for latent tuberculosis

infectionLavigne, et al.--2005

 

Relapse ofTuberculosis

Studies Reviewed

Smoking increases the risk of relapse after successful tuberculosis treatment

Batista, et al.--2008

Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a

hospital-based retrospective studySreeramareddy, et al.--2008

•Smokers less likely to have isolated extrapulmonary TB• History of TB associated with pulmonary TB•No identification if this was a relapse or reinfection•Reinfection more common in high burden countries

 

Mortality fromTuberculosis

Studies Reviewed

Smoking and risk of tuberculosis incidence, mortality, and recurrence in

South Korean men and womenJee, et al.--2009

Smoking and mortality from tuberculosis and other diseases in

India: retrospective study of 43 000 adult male deaths and 35 000 controls

Gajalakshmi, et al.--2009

 

Barcelona Tuberculosis

DataReviewed/ Analyzed

Tuberculosis and recurrence and its associated risk factors among successfully

treated patientsMillet, et al.--2009

Analysis of recent data collected by the Barcelona Public Health Agency

• Data collected on 5,141 males and females living in Barcelona•SPSS used to calculate frequencies and percentages for the following associations:•OUTCOME and:•sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, HIV status, and smoking status

•SMOKING STATUS and:• sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, and HIV status

Legionnaires’ Disease

• Legionella pneumophila• Low reporting rate• Can be lethal• Aerosol transmission• Risk factors:

• Old age• Smoking• Chronic lung disease• Immunosuppression

Legionnaires’ Diagnosis and Treatment

• Diagnosis• Chest x-ray• Sputum culture• Urinary antigen test• Blood antibody test

• Treatment• Antibiotics

http://www.wrongdiagnosis.com/phil/html/legionnaires-disease/192.html

 

Legionnaires’ Disease Data

Reviewed/ Analyzed

Sporadic community-acquired Legionnaires’ disease in France: a 2-year national matched case-control

studyChe, et al.--2008

Analysis of recent data collected by the Barcelona Public Health Agency

• Data collected on 1,018 males and females living in Barcelona•SPSS used to calculate frequencies and percentages for the following associations:•OUTCOME and:•sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status, and smoking status

•SMOKING STATUS and:• sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status

Acknowledgements 

• Josep M. Antó, Carme Borrell, Joana Porcel and CREAL staff• Joan A. Caylà• Angeles Orcau• Cecilia Tortasada• Lourdes Baezconde-Garbanati• Kathleen Dwyer• Daniel Soto and Camille Dennard• Rosa Barahona

References1. Tuberculosis (TB) (2009, June 1). In Center for Disease Control and Prevention. Retrieved July 11, 2011, from

http://www.cdc.gov/tb/topic/basics/default.htm2.   Associations between tobacco and tuberculosis. Chiang CY, Slama K, Enarson DA. International Union

Against Tuberculosis and Lung Disease, Paris, France. Int J Tuberc Lung Dis. 2007 Mar;11(3):258-62.   http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/17352089

3. Batista, J. L., Albuquerque, M. P., Ximenes, R. A., & Rodrigues, L. C. (2008, August). Smoking increases the risk of relapse after successful tuberculosis treatment. Int J Epidemiol, 37(4), 841-851. doi:10.1093/ije/dyn113

4. Brunet, L., Pai, M., Davids, V., Ling, D., Paradis, G., Lenders, L., & Meldau, R. (2011, July). High prevalence of smoking among patients with suspected tuberculosis in South Africa [Electronic version]. Eur Respir J., 38(1), 139-146.

5. Kolappan, C., & Gopi, P. G. Tobacco smoking and pulmonary tuberculosis. Thorax, 57(11), 964-966. Retrieved from PubMed (12403879).

6. Lavigne, M., Rocher, I., Steensma, C., & Brassard, P. (2006, March). The impact of smoking on adherence to treatment for latent tuberculosis infection [Electronic version]. BMC Public Health., 6, 66.

7. Sreeramareddy, C. T., Panduru, K. V., Verma, S. C., Joshi, H. S., & Bates, M. N. (2008, January). Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a  hospital-based retrospective study. BMC Infect Dis., 8, 8. doi:10.1186/1471-2334-8-8

8. Thomas, A., Gopi, P. G., Santha, T., Chandrasekaran, V., Subramani, R., Selvakumar, N., & Eusuff, S. I. (2005, May). Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India [Electronic version]. Int J Tuberc Lung Dis., 9(5), 556-561.

9. Gajalakshmi, V., Peto, R., Kanaka, T. S., & Jha, P. (2003, August 16). Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls [Electronic version]. Lancet, 362(9383), 507-515.

10. Millet, J. P., Orcau, A., Garcia de Olalla, P., Casals, M., Rius, C., & Cayla, J. A. (2009). Tuberculosis recurrence and its associated risk factors among successfully treated patients. J Epidemiol Community Health, 63, 799-804. doi:10.1136/jech.2008.077560

11. Che, D., Campese, C., Santa-Olalla, P., Jacquier, G., Bitar, D., Bernillon, P., & Desenclos, J. C. (2008, December). Sporadic community-acquired Legionnaires' disease in France: a 2-year national matched case-control study [Electronic version]. Epidemiol Infect., 136(12), 1684-1690.

12. Patient Facts: Learn More about Legionnaires' disease. (2011, June). In Legionellosis Resource Site (Legionnaires' Disease and Pontiac Fever). Retrieved July 14, 2011, from http://www.cdc.gov/legionella/patient_facts.htm

Questions