Tuberculosis in a Metropolitan Area of Northern Italy: Epidemiological Trends and Public Health Concerns

Abstract

As the most widespread infectious disease all over the world, tuberculosis is borne by increasing morbidity and mortality rates, both in industrialized and in developing countries. Changes in epidemiology patterns, atypical clinical-radiological manifestations, and the spread of chemotherapy-resistant strains, are prominent problems in the management of tuberculosis [1, 2]. The recent variation of a number of predisposing factors are altering both epidemiology and presentation of tuberculosis: the HIV pandemic, advancing age and concomitant illnesses (diabetes mellitus, lung and collagen vascular diseases), increasing immunodeficiency states (including iatrogenic ones), alcoholism and drug abuse, and especially immigration from regions where tuberculosis is endemic, or predisposition to acquire tuberculosis after arrival in Western countries, due to overwhelming social and economic problems [1, 3]. The recent immigration waves occurred in Italy (regarding hundred thousands people searching for work or escaping from war), are dramatically acting on the epidemiology of infectious diseases at both inpatient and outpatient settings. Should surveillance and public health preventive measures are insufficient, a spread of this contagious disease into the general population cannot be excluded, due to the recent, explosive increase of notifications [1, 3-5]. These changing features may be anticipated by some clearly recognizable trends in epidemiological, pathogenetic, and clinical features of tuberculosis in Italy. A retrospective analysis of clinical charts of patients hospitalized from 1996 to 2001 at our inpatient