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Risk factors for the development of active tuberculosis among persons infected with Mycobacterium tuberculosis

Risk factors for the development of active tuberculosis among persons infected with Mycobacterium tuberculosis
Risk factor Estimated risk for TB relative to persons with no known risk factor References
High risk
Acquired immunodeficiency syndrome (AIDS) 110 to 170 1,2
Human immunodeficiency virus infection (HIV) 50 to 110 3,4
Transplantation (related to immune-suppressant therapy) 20 to 74 5 to 8
Silicosis 30 9,10
Chronic renal failure requiring hemodialysis 10 to 25 11 to 14
Carcinoma of head and neck 16.0 15
Recent tuberculosis (TB) infection (≤2 years) 15.0 16,17
Abnormal chest radiograph with apical fibronodular changes typical of healed TB (not granuloma) 6 to 19 18 to 20
Tumor necrosis factor (TNF)-alpha inhibitors 1.7 to 9 21,22,35,36
Moderate risk
Treatment with glucocorticoids 4.9 23
Diabetes mellitus (all types) 2 to 3.6 24 to 27,37
Young age when infected (≤4 years) 2.2 to 5 28
Slightly increased risk
Underweight (<85 percent of ideal body weight); for most individuals this is equivalent to body mass index (BMI) ≤20 2 to 3 29
Cigarette smoker (1 pack/day) 2 to 3 30,31
Chest radiograph with solitary granuloma 2 20,32
Low risk
Infected person, no known risk factor, normal chest radiograph ("low-risk reactor") 1 33
Very low risk
Positive booster (two-step test) with no other known risk factor and normal chest radiograph) 0.5 Extrapolated from 33 and 34
References:
  1. Guelar A, Gatell JM, Verdejo J, et al. A prospective study of the risk of tuberculosis among HIV-infected patients. AIDS 1993; 7:1345.
  2. Antonucci G, Girardi E, Raviglione MC, et al. Risk factors for tuberculosis in HIV-infected persons. A prospective cohort study. JAMA 1995; 274:143.
  3. Wood R, Maartens G, Lombard CJ. Risk factors for developing tuberculosis in HIV-1 - Infected adults from communities with low or very high incidence of tuberculosis. J Acquir Immune Defic Syndr 2000; 23:75.
  4. Selwyn PA, Hartel D, Lewis VA, et al. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. New Engl J Med 1989; 320:545.
  5. Sakhuja V, Jha V, Varma PP, et al. The high incidence of tuberculosis among renal transplant recipients in India. Transplantation 1996; 61:211.
  6. Aguado JM, Herrero JA, Gavalda J, et al. Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Spanish Transplantation Infection Study Group, GESITRA. Transplantation 1997; 63:1278.
  7. Miller RA, Lanza LA, Kline JN, Geist LJ. Mycobacterium tuberculosis in lung transplant recipients. Am J Respir Crit Care Med 1995; 152:374.
  8. Meyers BR, Halpern M, Sheiner P, et al. Tuberculosis in liver transplant patients. Transplantation 1994; 58:301.
  9. Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council. A Double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Am Rev Respir Dis 1992; 145:36.
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  14. Pradhan RP, Katz LA, Nidus BD, et al. Tuberculosis in dialyzed patients. JAMA 1974; 229:798.
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  16. Sutherland I. Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli. Adv Tuberc Res 1976; 19:1.
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  22. Brassard P, Kezouh A, Suissa S. Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis 2006; 43:717.
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  24. Kim SJ, Hong YP, Lew WJ, et al. Incidence of pulmonary tuberculosis among diabetics. Tuber Lung Dis 1995; 76:529.
  25. Silwer H, Oscarsson PN. Incidence and coincidence of diabetes mellitus and pulmonary tuberculosis in a Swedish county. Acta Med Scand 1958; 161:1.
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  35. Wolfe F, Michaud K, Anderson J, et al. Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum 2004; 50:372.
  36. Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 2005; 52:1766.
  37. Lee MR, Huang YP, Kuo YT, et al. Diabetes mellitus and latent tuberculosis infection: a systemic review and meta-analysis. Clin Infect Dis 2016; pii:ciw836.
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