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Being a migrant and a woman, risk factors for developing severe forms of tuberculosis

Being a migrant and a woman, risk factors for developing severe forms of tuberculosis

A study led by Dr. Silvia Roure, head of the International Health and Neglected Diseases section of the Fight Infections Foundation, and Dr. Cristina Vilaplana of the Experimental Tuberculosis Unit, observes a considerable increase in the number of serious cases of tuberculosis in the metropolitan area of Barcelona during the period 2019-2021. This trend may reflect the impact of the COVID-19 pandemic, which coincided with a substantial reduction in diagnostic tests for this infection and subsequent access to health services. Research confirms that the migrant population residing in low-income areas has a higher prevalence of presenting severe clinical forms.

Tuberculosis is still a global public health problem that affects millions of people in the world, predominantly in countries where the income level is low or medium, but it also becomes a threat to the public health of countries. with a high level of income. Despite significant progress in recent decades, it is estimated that in 2016 in the world there were a total of 10.4 million people who contracted the disease, of which 1.6 million (16%) died. Of the people affected by tuberculosis, 90% were men, 10% were previously infected with HIV and 56% of the cases were located in five countries: India, Indonesia, China, the Philippines and Pakistan.

Disseminated tuberculosis

Disseminated tuberculosis is a severe form of tuberculosis in which Mycobacterium tuberculosis infection spreads throughout the body through the bloodstream and manifests itself by affecting two or more organs. Instead of being confined to the lungs, as in the typical pulmonary form of tuberculosis, the bacteria spread to other organs and tissues, such as the liver, kidneys, spleen, brain, and bones.

The study «Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis» presents a detailed analysis of a set of patients with disseminated tuberculosis who were diagnosed in the metropolitan area of Barcelona, from 2019 before the start of the COVID-19 pandemic, until the end of 2021. The research finds an increase in tuberculosis cases disseminated in the pandemic and post-pandemic context, coinciding with a notable diagnostic delay. The study aims to examine the link between delay in diagnosis and presentation of disseminated tuberculosis, to determine the underlying risk factors and to perform a detailed analysis of the clinical, imaging and laboratory findings of this form of tuberculosis.

Increase in tuberculosis cases

The study contemplates a retrospective analysis of all new cases of disseminated tuberculosis diagnosed at the Germans Trias i Pujol University Hospital in Badalona, from January 2019 to December 2021. This is the reference hospital for the Northern Crown of the Metropolitan Area of Barcelona. with 406,000 inhabitants. Immigrants make up approximately 17% of the population. For all patients diagnosed with disseminated tuberculosis, sociodemographic, clinical, and laboratory data were collected, including patient age, sex, body mass index (BMI), country or region of origin, current household location, and primary and secondary foci of tuberculosis in diagnosis and laboratory and imaging results. Additionally, the date of the first contact with the health system in which symptoms compatible with the initial focus of tuberculosis were diagnosed and the number of visits between the first symptoms recorded and the final diagnosis of the infection were noted.

The migrant population most susceptible to infection

Migrant population communities tend to be populations with few resources and risk factors associated with the transmission of tuberculosis. They are also more likely to develop underlying conditions related to poverty that increase the risk of developing tuberculosis disease, such as malnutrition, alcohol abuse, and diabetes mellitus. They also often experience sociocultural barriers to accessing health services. All of these factors can increase the risk of tuberculosis disease and a delay in its diagnosis.


The team leading the research observed a sharp increase in the number of disseminated tuberculosis cases during the post-pandemic period, which is difficult to consider as a random oscillation. This trend may reflect the impact of the COVID-19 pandemic, which in many countries around the world has led to a substantial reduction in tuberculosis testing and access to health services.
Dr. Silvia Roure, head of the International Health and Neglected Diseases section of the Fight Infections Foundation, comments that to achieve a greater reduction in tuberculosis in Catalonia in the coming years, it is necessary to design joint actions between healthcare professionals. healthcare services and public health services, as well as promoting intersectoral and interdepartmental actions. To the efforts to control tuberculosis, it is necessary to add efforts to eliminate it, identifying and treating cases of latent tuberculosis infection to reduce the reservoir of the causal agent of this disease. Likewise, the doctor points out that tuberculosis containment programs must encompass cultural, economic and medical aspects of the disease, as well as have a special impact on immigrant population groups and especially women.

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