ABSTRACT
BACKGROUND: Tuberculosis (TB) incidence remains low in health departments of Castellon and La Plana-Vila-real, but TB elimination is challenging. The objective of this study was to estimate associated factors of pulmonary tuberculosis (PTB) compared with extrapulmonary tuberculosis (ETB) and investigate epidemiological characteristics of these pathologies to orient control and prevention actions. MATERIALS AND METHODS: A prospective case-case study was implemented by comparing PTB and ETB incidences during 2013-2016 from notification reports, epidemiological surveillance, and microbiological results of hospitals' laboratories Hospital General Castellon and La Plana-Vila-Real in the province of Castellon of Valencia region in Spain. In this design, cases were patients with PTB and controls were patients with ETB. Directed acyclic graph approach was used for selection of potential risk and confounding factors. Adjusted odds ratios (AORs) were estimated by logistic regression models. RESULTS: The study included 136 patients with PTB and 57 patients with ETB, with microbiological confirmation of 93.4% and 52.6%, and the annual median of incidence rates were 7.5 and 3.1 per 100 000 inhabitants, respectively. In general, patients with PTB were younger with higher male proportion than patients with ETB. Risk factors of PTB were smoking tobacco (AOR = 3.98; 95% confidence interval [CI] = 1.66-9.56), social problems (social marginalization, homeless, residence in shelters for the poor, or stay in prison) (AOR = 3.39; 95% CI = 1.05-10.94), and contact with patients with TB (AOR = 2.51; 95% CI = 1.06-5.95). No-smoking tobacco and no-drug abuse interaction decrease PTB risk (AOR = 0.27; 95% CI = 0.12-0.64). From these results, specific measures of health promotion and prevention can be addressed. CONCLUSIONS: The estimated associated factors of PTB may be prevented, and it was demonstrated that the case-case design is useful in the study of TB.
ABSTRACT
INTRODUCTION: Salmonella infections (SI) are common in Spain. The aim of this study was to appraise risk factors and the clinical characteristics of sporadic Salmonella Typhimurium infections compared with other sporadic salmonella serotype infections (OSI). METHODS: From September 2014 to August 2015, a case-case study was carried out by the Epidemiology Division of the Public Health Centre of Castellon. Case 1 consisted of patients with sporadic S. Typhimurium infections, while case 2 comprised OSI patients, assessed according to the stool cultures analyzed by the Microbiology Laboratories of Hospital General de Castellon and Hospital de La Plana in Vila-real. Patients from detected outbreaks were not included. The salmonella serotype was identified by the National Centre of Microbiology (Madrid). RESULTS: The total number of SI patients reported was 327, 242 of whom were studied (74.0%). 148 patients had sporadic S. Typhimurium infection and 64 had OSI, with median ages of 4 and 8.5 years, respectively. Sporadic S. Typhimurium infection patients presented more blood in feces and diarrhea episodes. Consumption of pork meat (OR = 2.22; 95% CI 1.12-4.43), cold pork meats (OR = 2.49; 95% CI 1.32-4.68) and playing in the dirt (OR=3.02; 95% CI 1.55-5.88), were associated with sporadic S. Typhimurium infection. In the 0-4 year-old group, the associated factors were consumption of cold pork meats, omelets and female gender. In the 5-year-old and over group, only playing in soil was associated with sporadic S. Typhimurium infection. CONCLUSIONS: The consumption of pork and omelets, as well as playing in the dirt, were the main factors associated with infection. Children were most affected by sporadic S. Typhimurium infection
INTRODUCCIÓN: Las infecciones por Salmonella son frecuentes en España. El objetivo de este estudio fue estimar factores de riesgo y características de las infecciones esporádicas por Salmonella typhimurium (IET), comparadas con infecciones esporádicas por otros serotipos de Salmonella. MÉTODOS: Desde septiembre de 2014 a agosto de 2015 se efectuó un estudio caso-caso por la Sección de Epidemiología del Centro de Salud Pública de Castellón. El caso 1 fueron los pacientes con IET y el caso 2 aquellos con infecciones esporádicas por otros serotipos de Samonella, según los coprocultivos realizados por los laboratorios de Microbiología de los hospitales General de Castellón y La Plana de Vila-real, sin incluir los pacientes de brotes detectados. El serotipo de Salmonella fue identificado en el Centro Nacional de Microbiología (Madrid). RESULTADOS: Se notificaron 327 pacientes con infección por Salmonella, de los que 242 fueron estudiados (74,0%). Ciento cuarenta y ocho pacientes tenían IET y 64, infecciones esporádicas por otros serotipos de Salmonella, con una mediana de edad de 4 y 8,5 años, respectivamente. Los pacientes IET presentaron más episodios diarreicos y sangre en las heces. El consumo de carne de cerdo (OR 2,22; IC 95% 1,12-4,43), fiambres de cerdo (OR 2,49; IC 95% 1,32-4,68) y jugar en la tierra (OR 3,02; IC 95% 1,55-5,88) fueron asociados con IET. En el grupo de 0-4 años, los factores asociados fueron consumo de fiambres de cerdo, tortillas y ser mujer. En el grupo de 5 y más años, solo jugar en la tierra fue asociado con IET. CONCLUSIONES: El consumo de productos porcinos y tortillas, así como jugar en la tierra fueron los factores asociados, y los niños, los más afectados
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Salmonella/classification , Salmonella/isolation & purification , Salmonella Infections/microbiology , Salmonella Infections/epidemiology , Foodborne Diseases/microbiology , Foodborne Diseases/epidemiology , Salmonella typhimurium/isolation & purification , Spain/epidemiology , Risk Factors , SerotypingABSTRACT
INTRODUCTION: Salmonella infections (SI) are common in Spain. The aim of this study was to appraise risk factors and the clinical characteristics of sporadic Salmonella Typhimurium infections compared with other sporadic salmonella serotype infections (OSI). METHODS: From September 2014 to August 2015, a case-case study was carried out by the Epidemiology Division of the Public Health Centre of Castellon. Case 1 consisted of patients with sporadic S. Typhimurium infections, while case 2 comprised OSI patients, assessed according to the stool cultures analyzed by the Microbiology Laboratories of Hospital General de Castellon and Hospital de La Plana in Vila-real. Patients from detected outbreaks were not included. The salmonella serotype was identified by the National Centre of Microbiology (Madrid). RESULTS: The total number of SI patients reported was 327, 242 of whom were studied (74.0%). 148 patients had sporadic S. Typhimurium infection and 64 had OSI, with median ages of 4 and 8.5 years, respectively. Sporadic S. Typhimurium infection patients presented more blood in feces and diarrhea episodes. Consumption of pork meat (OR=2.22; 95% CI 1.12-4.43), cold pork meats (OR=2.49; 95% CI 1.32-4.68) and playing in the dirt (OR=3.02; 95% CI 1.55-5.88), were associated with sporadic S. Typhimurium infection. In the 0-4 year-old group, the associated factors were consumption of cold pork meats, omelets and female gender. In the 5-year-old and over group, only playing in soil was associated with sporadic S. Typhimurium infection. CONCLUSIONS: The consumption of pork and omelets, as well as playing in the dirt, were the main factors associated with infection. Children were most affected by sporadic S. Typhimurium infection.
