Tackling TB in migrants arriving at Europe’s southern border

Over a quarter of the individuals diagnosed with tuberculosis [TB] in the European Union region are born outside of the area and the proportion has been increasing steadily. Italy is a low TB incidence country with over 50% of TB cases in the foreign-born population primarily due to the high numbers of migrants entering the country via land or sea. As a case study to evaluate the value of screening in newly arrived migrants, the EDETECT-TB project in Italy implemented and evaluated active TB screening in the migrant population at first reception centres to ensure early diagnosis to avoid further spread. Based on a cost-effectiveness analysis from a program provider perspective, a decision tree model allowed the assessment of the value for money of case finding by estimating the cost per case of active TB detected compared with the status quo of no screening. The analysis confirmed that early case detection is a cost-effective intervention in areas with migrants arriving from high TB risk settings. Targeted post-arrival early screening of high TB risk vulnerable new entrants to Italy has a potential role in reducing the spread of TB among migrants

Mycobacterium tuberculosis in ospedale: è patogeno nosocomiale? oppure occupazionale?

La tubercolosi costituisce una emergenza sanitaria per la salute pubblica, oltre che una problematica confinata agli ambienti lavorativi. Per tale ragione le autorità sanitarie redigono ed aggiornano costantemente linee guida di notevole valore scientifico e pratico. Recenti episodi di cronaca hanno riportato alla ribalta la tubercolosi come patologia nosocomiale, la cui trasmissione può avvenire da operatore sanitario a paziente. Per quanto concerne gli operatori sanitari, una recente revisione della letteratura ha confermato che il rischio di infezione tubercolare latente e di tubercolosi sono maggiori in questa categoria rispetto alla popolazione generale. Gli strumenti di riduzione del rischio di tubercolosi in ambito nosocomiale si basano innanzitutto sull’adozione di misure di isolamento respiratorio; tuttavia tali procedure richiedono il rapido riconoscimento del sospetto clinico. La diagnosi microbiologica di tubercolosi si basa sul reperto di bacilli tubercolari nel campione clinico. La ricerca di tali microrganismi può essere eseguita con l’esame microscopico, colturale e con tecniche rapide di biologia molecolare.Tuberculosis is an emergency for public health, as well as an issue confined to working environments. For this reason, the health authorities draw up and regularly update guidelines of considerable scientific and practical value. Recent reports have shown tuberculosis as a nosocomial disease whose transmission can occur from healthcare environment to patient. With regard to healthcare workers, a recent literature review confirmed that the risk of latent TB infection and tuberculosis is greater in this category of workers than in the general population. The tools for risk reduction in nosocomial TB are based primarily on respiratory isolation measures. However such procedures require the rapid recognition of clinical suspicion. The microbiological diagnosis of tuberculosis is based on the detection of tubercular bacilli in clinical specimens. The research of these microorganisms can be done using microscopic and coltural examination as well as rapid molecular biology techniques

Exposure to environmental tobacco smoke is associated with lower plasma β-carotene levels among nonsmoking women married to a smoker

We evaluated the association between exposure to environmental tobacco smoke (ETS) from husbands who smoke and plasma levels of antioxidant vitamins among nonsmoking women. A total of 1249 women from four areas in Italy answered a self-administered questionnaire, reported their diets on a food frequency questionnaire, had a medical examination, and gave their blood for and β-carotene, retinol, L-ascorbic acid, α-tocopherol, and lycopene determinations. Urinary cotinine was used to evaluate the level of recent exposure to ETS. After adjusting for study center, age and education, we found no association between ETS exposure and daily nutrient intake of β-carotene, retinol, L-ascorbic acid, and α-tocopherol. However, we found an inverse dose-response relationship between intensity of current husband's smoke and concentrations of plasma β-carotene and L-ascorbic acid. The associations remained even after controlling for daily β-carotene and vitamin C intake and for other potential confounders (vitamin supplementation, alcohol consumption, and body mass index). Moreover, when urinary cotinine was considered as the exposure variable, a significant inverse association with plasma β-carotene was found. The findings may be of interest to explain the biological mechanism that link ETS exposure with lung cancer and ischemic heart diseases