Tuberculosis Epidemiology and Drug Resistance Among Immigrants and Natives in a City of Northern Italy

Background Italy is a low tuberculosis (TB) burden country, and its drug-resistant TB incidence is low, (Multi-Drug-Resistant -MDR-TB incidence: 0.24/100000). Most TB cases cluster among immigrants and in metropolitan areas. The present study describes epidemiological and drug-resistant TB features among natives and immigrants between 2009 and 2018, in a low TB burden and high immigrant receiving setting (Ferrara, a city of North-East, Italy). Methods We retrospectively and prospectively identified all TB cases admitted to Ferrara University-Hospital from January 2009 to October 2018. We recorded epidemiological data, HIV-status, site of disease, smear positivity, culture results, sensitivity to first- and second-line anti-TB drugs. Results We recorded 248 TB cases, 137 males and 111 females. Immigrants (64%) were younger than natives (35.4 vs 62.9 years, p<0.01). Twelve patients were HIV-positive (8 immigrants, 5 natives). The proportion of immigrant cases and the proportion of resistant TB cases did not show any increasing trend over the study period. East-Europeans presented more frequently pulmonary TB (PTB; 38/45 cases), whereas Asians, extrapulmonary TB (EPTB; 22/43) (p<0.01). A positive smear was recorded in 47/103 (45.6%) immigrants and 19/68 (27.9%) natives (p<0.05). Antibiotic resistance profile was available in 146/148 culture confirmed cases (98.6%). Being immigrant, East-European or Asian, HIV-positive or presenting with PTB did not associated with resistant TB (p>0.05). All MDR (2/148) and extensively-resistant (XDR) (1/148) cases were East-European and smear-negative cases. No increasing or decreasing trend in TB drug resistance profile was observed among immigrants and natives over the study period. Conclusions In our setting, immigrants were younger than natives. No difference in anti-TB drug sensitivity between immigrants and natives was observed. Most PTB cases did come from East-Europe, whereas EPTB cases from Asia. Smear positivity rate was higher among immigrants. However, reasons for these findings were not investigated and require further studies.