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 Table of Contents  
EDITORIAL COMMENTARY
Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 326-327

Risk factors for tuberculosis and beyond


Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Saudi Arabia

Date of Web Publication17-Nov-2017

Correspondence Address:
Sahal A Al-Hajoj
Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Post Box #3354, Riyadh 11211
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_145_17

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How to cite this article:
Al-Hajoj SA. Risk factors for tuberculosis and beyond. Int J Mycobacteriol 2017;6:326-7

How to cite this URL:
Al-Hajoj SA. Risk factors for tuberculosis and beyond. Int J Mycobacteriol [serial online] 2017 [cited 2017 Dec 16];6:326-7. Available from: http://www.ijmyco.org/text.asp?2017/6/4/326/218629



In this article, risk factors for tuberculosis (TB) death have been retrospectively explored in a tertiary hospital in Oman. During the study, 205 TB cases were reviewed and only 31 (15%) TB deaths were detected.[1] Authors of the current manuscript have identified advanced age, low-body weight, negative sputum TB smear, pulmonary involvement, human immunodeficiency virus infection, and noncitizen status as the main risk factors associated with TB mortality in Oman.

Factors contributing toward increasing TB-susceptibility and mortality are not well understood in the Gulf region and worldwide. Thereby, taking into consideration, the objectives and findings of this paper, I highly believe that these findings have a particular clinical value to researches and health authorities in the region. These findings may enable the optimization of control strategies and thereby reducing the overall death of TB cases.[2] However, in my judgment, we also need larger scale studies to characterize not only the risk factors associated with TB mortality but also the risk factors associated with increasing susceptibility to mycobacterium tuberculosis (MTB) infections in the first place. Understanding and tackling risk factors associated with TB infections is a very crucial step to ultimately reduce TB prevalence in such settings. Risk factors associated with MTB infections include living standard, multidrug resistance (MDR-TB), socioeconomic factors, and stigma. The latter factor is one of the major contributors to the worldwide dissemination of M. tuberculosis complex (MTBC) infections.

Stigma is defined as a process that occurs when an individual is identified as being undesirable or disvalued due to a particular trait or characteristic.[3] In addition, researchers have subclassified stigma into three different categories: experienced, anticipated, and internalized. Regardless its type, stigma indeed has devastating consequences on TB patients and TB control. Indeed, stigma impedes TB preventive measures such as coughing-hygiene and good ventilation systems at homes resulting in an increasing transmission risk, severe morbidity and mortality rates, and increasing development of MDR-TB cases. All together, these factors will result in lower success rate of TB control in any given setting.[4] Stigma constitutes one of the major social factors causing hospital delay and hindering compliance of TB patients. Hence, stigma is often referred to as the silent killer.[5]

In communities like those living in the Gulf region, stigma warrants further investigation, especially among conservative communities. These communities often keep diseases such as TB highly confidential due to fears of being subjected to social shaming. Similar beliefs and attitudes have been documented in many other countries where stigma has been investigated previously.[2] Many individuals and families prefer not to speak bout diseases and often show reluctant behaviors toward TB-treatment. By the time, patients start seeking treatment; they might have infected many members of their society and house-contacts.

We are aware that stigma is not the only contributing factor in this regards, and many other factors seem to contribute toward the increasing susceptibility to the infection and later may be increase mortality and morbidity of TB patients. These factors include virulence of the pathogen, status of immune system, and socioeconomic factors. However, some of these factors, such as MTBC virulence features and host-related, are indeed difficult to control or manipulate. Therefore, we should exert extra efforts to tackle factors that can be controlled and manipulated such as TB stigmatization.[5],[6] This theme (investigating and manipulating risk factors which can drastically reduce the spreading of MTB infections) goes very well with the idiom that says “an ounce of prevention is better than a pound of cure.” As such we encourage and demand our colleagues, researcher and scientists to focus more on this branch of research (qualitative research) and to explore the social factors responsible for the spread of MTB infections in our communities. Without understanding such factors and tackling them appropriately, MTB infections will remain as prevalent as ever.



 
  References Top

1.
Gazifer ZA. Risk Factos for Tuberculosis Mortality in a Tertiary Care Center in Oman, 2006–2016. Int J Mycobacteriology 2017;6:356-60.  Back to cited text no. 1
    
2.
Tadesse S. Stigma against tuberculosis patients in addis Ababa, Ethiopia. PLoS One 2016;11:e0152900.  Back to cited text no. 2
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3.
Cervantes J. Tuberculosis. Digging deep in the soul of humanity. Respir Med 2016;119:20-2.  Back to cited text no. 3
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4.
Cremers AL, de Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP. Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS One 2015;10:e0119861.  Back to cited text no. 4
[PUBMED]    
5.
Jittimanee SX, Nateniyom S, Kittikraisak W, Burapat C, Akksilp S, Chumpathat N, et al. Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand. PLoS One 2009;4:e6360.  Back to cited text no. 5
[PUBMED]    
6.
Courtwright A, Turner AN. Tuberculosis and stigmatization: Pathways and interventions. Public Health Rep 2010;125 Suppl 4:34-42.  Back to cited text no. 6
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