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RISK FACTORS

According to CDC, Center for Disease Control and Prevention, generally, persons at high risk
for developing TB disease fall into two categories:
a. Persons who have been recently infected with TB bacteria
b. Persons with medical conditions that weaken the immune system
Persons who have been recently infected with TB bacteria include:
- Close contacts of a person with infectious TB disease
- Persons who have immigrated from areas of the world with high rates of TB
- Children less than 5 years of age who have a positive TB test
- Groups with high rates of TB transmission, such as homeless persons, injection drug
users, and persons with HIV infection
- Persons who work or reside with people who are at high risk for TB in facilities or
institutions such as hospitals, homeless shelters, correctional facilities, nursing
homes, and residential homes for those with HIV
Persons with medical conditions that weaken immune system include:
- HIV infection (the virus that causes AIDS)
- Substance abuse
- Silicosis
- Diabetes mellitus
- Severe kidney disease
- Low body weight
- Organ transplants
- Head and neck cancer
- Medical treatments such as corticosteroids or organ transplant
- Specialized treatment for rheumatoid arthritis or Crohn’s disease (CDC, 2016)
There is also comorbidities that comes with TB, according to WHO they are:
a. TB and HIV
People living with HIV are from 26-31 times more likely to develop TB than persons
without HIV. TB is the most common presenting illness among people living with HIV,
including among those taking antiretroviral treatment and it is the major cause of
HIV-related death. In 2016, there were an estimated 1.3 million TB deaths among
HIV-negative people and an additional 374 000 deaths among HIV-positive people.
b. TB and Diabetes
Diabetes triples the risk of TB. Consequently, rates of TB are higher in people with
diabetes than in the general population, and diabetes is a common comorbidity in
people with TB. Diabetes can worsen the clinical course of TB, and TB can worsen
glycaemic control in people with diabetes. (World Health Organization, International
Union Againts Tuberculosis and Lung Disease, 2011)
c. TB and Nutritions
Malnutrition increases the risk of TB and TB can lead to malnutrition. Malnutrition is
therefore often highly prevalent among people with TB. While appropriate TB
treatment often helps normalize nutritional status, many TB patients are still
malnourished at the end of TB treatment. Therefore, nutritional assessment and
counselling, and management of malnutrition based on the nutritional status are an
important part of the TB treatment package.
d. TB and Tobacco Smoking
Tobacco smoking increases the risk of TB 2-3 fold, and is associated with poor TB
treatment results. Smoking prevalence is often high among people with TB, and
prevalence of other smoking-related conditions can be high as well. People
diagnosed with TB should be asked about smoking, and should be offered advice
about smoking cessation. This is part of the practical approach to lung health. (World
Health Organization, International Union Againts Tuberculosis and Lung Disease,
2007)
e. TB and harmful use of alcohol
Harmful use of alcohol increases the risk of TB threefold, and is also a strong risk
factor for poor TB treatment adherence. In countries with high prevalence of alcohol
use disorders, and especially in intermediate- and low-incidence countries where TB
has become highly concentrated to certain vulnerable groups, harmful alcohol use
can be an important population level risk factor for TB, and is often a common co-
morbidity among TB patients. As part of a comprehensive care package it is
important, especially in those countries, to identify problem drinkers, diagnose
alcohol use disorder, and refer for appropriate alcohol interventions.

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