Tuberculosis in African refugees from the eastern sub-Sahara region

Background: The southern region of Israel has recently experienced an influx of African refugees from the Eastern Sub- Sahara desert area. These influxes have led to a significant increase in incidence of tuberculosis (TB) in that region. Objectives: To review the data of African refugees diagnosed with TB between January 2008 and August 2010 at a tertiary care regional hospital. Results: Twenty-five TB cases were diagnosed, 22 of which presented with pulmonary TB, 3 with extra-pulmonary TB (EPTB), and 7 with combined pulmonary and EPTB. Only one case had concomitant human immunodeficiency virus (HIV) infection and multidrug-resistant TB. Fifteen patients underwent extensive radiological investigations including chest, abdominal and spine computed tomography, 1 was reviewed by magnetic resonance imaging, and 9 underwent tissue biopsy. Eighteen patients were admitted as suspected TB and 4 as suspected pneumonia or pulmonary infiltrates that could have been defined as suspected TB. All 24 HIV-negative cases were sensitive to first-line drugs for TB, except for one case that was resistant to streptomycin and one to rifampicin. All patients responded well to first-line therapy. The average duration of hospitalization was 8.7 days (range 1-36). Following diagnosis 23 patients were transferred to a quarantine facility. Conclusions: We identified overutilization of medical resources and invasive procedures. For African refugees from the eastern Sub-Sahara who were HIV-negative and suspected of having TB, a sputum acid-fast smear and culture should have been the primary investigative tools before initiating treatment with four drugs (first-line), and further investigations should have been postponed and reserved for non-responders or for patients for whom the culture was negative. Physicians should maintain a high index of suspicion for EPTB in this population.