Extrapulmonary tuberculosis among immigrants in a low-TB burden and high immigrant receiving city of northern Italy

Introduction: The constantly increasing immigration flows are influencing tuberculosis (TB) epidemiology in several European countries as well as in Italy. Extrapulmonary tuberculosis (EPTB) incidence rate is not decreasing and, among immigrants, it occurs in a remarkable number of cases. This study aimed to provide further insights regarding EPTB among natives and immigrants in a low TB burden and high immigrant receiving setting.Methodology: A total of 217 TB cases admitted to the University-Hospital of Ferrara from 2009 through 2015 were enrolled in the study. Clinical and demographical data including age, gender, origin, single comorbidities such as HIV status, chronic viral disease, chronic lung disease, diabetes, neoplasm, and multimorbidity were analyzed.Results: Of the 217 cases enrolled, 60.0% were immigrants and 40.0% natives, 68.7% presented pulmonary TB and 31.3% EPTB. By binary logistic regression, we observed that female gender (O.R. (95% C.I.): 1.95 (1.08-3.50), p < 0.05), Asian origin (5.70 (2.00-16.24), p < 0.001) and multimorbidity (6.42 (2.37-17.41), p < 0.001) were significantly associated to the development of EPTB compared to PTB. Nodal TB was the most common site of reactivation (56.5% among immigrants and 27.3% among natives).Conclusions: The data we found could be useful in increasing EPTB medical suspicion and decreasing EPTB diagnostic delay in low TB burden and high immigrant receiving settings.