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Impact of Immigration on Pulmonary Tuberculosis in Spanish Children: A Three-Decade Review

del Rosal, Teresa MD*; Baquero-Artigao, Fernando MD*; García-Miguel, María Jesús MD*; Méndez-Echevarría, Ana MD*; López, Goosen MD; Aracil, Francisco Javier MD, PhD*; de José, María Isabel MD, PhD*; del Castillo, Fernando MD, PhD*

The Pediatric Infectious Disease Journal: July 2010 - Volume 29 - Issue 7 - p 648-651
doi: 10.1097/INF.0b013e3181d5da11
Original Studies

Background: Tuberculosis causes significant morbidity and mortality worldwide. In the last years, international travel and immigration have led to important changes in the epidemiology of this disease. Drug resistance has emerged as an important threat to tuberculosis control. Data regarding the impact of immigration and the incidence of drug-resistant strains in children are lacking.

Methods: Retrospective review of patients diagnosed with pulmonary tuberculosis at La Paz Children's Hospital in a 30-year period. Data were collected with regard to the clinical, radiologic, microbiologic, and demographic characteristics of patients, and data from the 3 decades of the study were compared using χ2 test and Fisher exact test.

Results: A total of 507 cases of tuberculosis were identified, 414 of which had pulmonary involvement. During the study, there was a significant decrease in tuberculous meningitis: 10.4% in 1978–1987, 5.6% in 1988–1997, and 2.9% in 1998–2007 (P < 0.05). The most frequent reason for a consultation was case contact investigation. The adult source case was identified in 64% of patients. We observed an increase in extrafamilial contacts (8% in 1978–1987 and 18% in 1998–2007, P < 0.01), including 4 cases of immigrant caretakers. Tuberculosis in immigrant children has increased with time: 2% in the period 1978–1987, 6% in 1988–1997, and 46% in 1998–2007 (P < 0.001). The primary resistance rate to isoniazid in our population was 6.5%.

Conclusions: Tuberculosis in our area continues to be a major health problem, especially among foreign-born children. As drug-resistant strains are increasing, initial therapy with 4 drugs is recommended in our population.


From the *Pediatric Infectious Diseases Unit, and †Microbiology Department, La Paz Hospital, Madrid, Spain.

Accepted for publication January 25, 2010.

Address for correspondence: Teresa del Rosal Rabes, La Paz Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.