Smoking and Infectious
Disease
Tuberculosis and Legionnaires'
Disease
Sarah Pickett, Farva Jafri, and Souraya Sourayanezhad
University 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.health.state.mn.us/divs/idep
c/diseases/tb/tst.html
http://www.cmaj.ca/content/169/9/937.full
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
Latent
Tuberculosis
Studies Reviewed
High prevalence of smoking among patients
with suspected tuberculosis in South Africa
Burnet, et al.--2011
The impact of smoking on adherence to
treatment for latent tuberculosis infection
Lavigne, et al.--2005
Relapse of
Tuberculosis
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 study
Sreeramareddy, 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 from
Tuberculosis
Studies Reviewed
Smoking and risk of tuberculosis incidence,
mortality, and recurrence in South Korean
men and women
Jee, 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 Data
Reviewed/
Analyzed
Tuberculosis and recurrence and its associated
risk factors among successfully treated patients
Millet, 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 study
Che, 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
References
1.
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.htm
2.
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):25862. 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), 139146.
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