1. Smoking and Infectious Disease Tuberculosis and Legionnaires' Disease Sarah Pickett, Farva Jafri, and Souraya Sourayanezhad University of Southern California, MPH, 2011

2. Tuberculosis Mycobacterium Tuberculosis Aerosol transmission Latent vs. active tuberculosis

3. The association between smoking and tuberculosis has been investigated since 1918

4. Tuberculosis Diagnosis Latent TB granulomas can be seen on a chest xray Mantoux skin test http://www.cmaj.ca/content/169/9/937.full http://www.health.state.mn.us/divs/idep c/diseases/tb/tst.html

5. Tuberculosis Treatment Suggested treatment according to the CDC includes: o ACTIVE-- isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA) o LATENT--  isoniazid (INH)

6. Tuberculosis Prevalence Tuberculosis (TB) is one of the most important infectious diseases in the world in terms of morbidity and mortality In 2008, the number of deaths due to TB was estimated at 1.8 million by the World Health Organization (WHO) In 2008, an estimated 0.48 million new cases occurred in South Africa and, currently, the country ranks third after India and China in terms of total number of annual incident cases of TB

8. Active Tuberculosis Studies Reviewed

9. The reduction of tuberculosis risks by smoking cessation Wen, et al.--2010

10. Tobacco smoking and pulmonary tuberculosis Kolappan, Gopi--2002

11. Latent Tuberculosis Studies Reviewed

12. High prevalence of smoking among patients with suspected tuberculosis in South Africa Burnet, et al.--2011

13. The impact of smoking on adherence to treatment for latent tuberculosis infection Lavigne, et al.--2005

14. Relapse of Tuberculosis Studies Reviewed

15. Smoking increases the risk of relapse after successful tuberculosis treatment Batista, et al.--2008

16. Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study Sreeramareddy, et al.--2008 Smokers less likely to have isolated extrapulmonary TB History of TB associated with pulmonary TB No identification if this was a relapse or reinfection Reinfection more common in high burden countries

17. Mortality from Tuberculosis Studies Reviewed

18. Smoking and risk of tuberculosis incidence, mortality, and recurrence in South Korean men and women Jee, et al.--2009

19. Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43 000 adult male deaths and 35 000 controls Gajalakshmi, et al.--2009

20. Barcelona Tuberculosis Data Reviewed/ Analyzed

21. Tuberculosis and recurrence and its associated risk factors among successfully treated patients Millet, et al.--2009

22. Analysis of recent data collected by the Barcelona Public Health Agency Data collected on 5,141 males and females living in Barcelona SPSS used to calculate frequencies and percentages for the following associations: OUTCOME and: sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, HIV status, and smoking status SMOKING STATUS and: sex, country of origin, diabetes status, alcohol, homelessness, DOT therapy, imprisonment status, and HIV status

25. Legionnaires’ Disease Legionella pneumophila Low reporting rate Can be lethal Aerosol transmission Risk factors: Old age Smoking Chronic lung disease Immunosuppression

26. Legionnaires’ Diagnosis and Treatment Diagnosis Chest x-ray Sputum culture Urinary antigen test Blood antibody test Treatment Antibiotics http://www.wrongdiagnosis.com/phil/html/legionnaires-disease/192.html

27. Legionnaires’ Disease Data Reviewed/ Analyzed

28. Sporadic community-acquired Legionnaires’ disease in France: a 2-year national matched case-control study Che, et al.--2008

29. Analysis of recent data collected by the Barcelona Public Health Agency Data collected on 1,018 males and females living in Barcelona SPSS used to calculate frequencies and percentages for the following associations: OUTCOME and: sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status, and smoking status SMOKING STATUS and: sex, country of origin, diabetes status, alcohol, cardiopulmonary disease, immunosuppressive treatment and disease, renal transplant, cancer status

31. Acknowledgements Josep M. Antó, Carme Borrell, Joana Porcel and CREAL staff Joan A. Caylà Angeles Orcau Cecilia Tortasada Lourdes Baezconde-Garbanati Kathleen Dwyer Daniel Soto and Camille Dennard Rosa Barahona

32. References 1.Tuberculosis (TB) (2009, June 1). In Center for Disease Control and Prevention. Retrieved July 11, 2011, from http://www.cdc.gov/tb/topic/basics/default.htm 2. Associations between tobacco and tuberculosis. Chiang CY, Slama K, Enarson DA. International Union Against Tuberculosis and Lung Disease, Paris, France. Int J Tuberc Lung Dis. 2007 Mar;11(3):258- 62. http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/17352089Chiang CYSlama KEnarson DAInt J Tuberc Lung Dis.http://www.ncbi.nlm.nih.gov.libproxy.usc.edu/pubmed/17352089 3.Batista, J. L., Albuquerque, M. P., Ximenes, R. A., & Rodrigues, L. C. (2008, August). Smoking increases the risk of relapse after successful tuberculosis treatment. Int J Epidemiol, 37(4), 841-851. doi:10.1093/ije/dyn113 4.Brunet, L., Pai, M., Davids, V., Ling, D., Paradis, G., Lenders, L., & Meldau, R. (2011, July). High prevalence of smoking among patients with suspected tuberculosis in South Africa [Electronic version]. Eur Respir J., 38(1), 139- 146. 5.Kolappan, C., & Gopi, P. G. Tobacco smoking and pulmonary tuberculosis. Thorax, 57(11), 964-966. Retrieved from PubMed (12403879). 6.Lavigne, M., Rocher, I., Steensma, C., & Brassard, P. (2006, March). The impact of smoking on adherence to treatment for latent tuberculosis infection [Electronic version]. BMC Public Health., 6, 66. 7.Sreeramareddy, C. T., Panduru, K. V., Verma, S. C., Joshi, H. S., & Bates, M. N. (2008, January). Comparison of pulmonary and extrapulmonary tuberculosis in Nepal-a hospital-based retrospective study. BMC Infect Dis., 8, 8. doi:10.1186/1471-2334-8-8 8.Thomas, A., Gopi, P. G., Santha, T., Chandrasekaran, V., Subramani, R., Selvakumar, N., & Eusuff, S. I. (2005, May). Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India [Electronic version]. Int J Tuberc Lung Dis., 9(5), 556-561. 9.Gajalakshmi, V., Peto, R., Kanaka, T. S., & Jha, P. (2003, August 16). Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls [Electronic version]. Lancet, 362(9383), 507-515. 10.Millet, J. P., Orcau, A., Garcia de Olalla, P., Casals, M., Rius, C., & Cayla, J. A. (2009). Tuberculosis recurrence and its associated risk factors among successfully treated patients. J Epidemiol Community Health, 63, 799-804. doi:10.1136/jech.2008.077560 11.Che, D., Campese, C., Santa-Olalla, P., Jacquier, G., Bitar, D., Bernillon, P., & Desenclos, J. C. (2008, December). Sporadic community-acquired Legionnaires' disease in France: a 2-year national matched case-control study [Electronic version]. Epidemiol Infect., 136(12), 1684-1690. 12.Patient Facts: Learn More about Legionnaires' disease. (2011, June). In Legionellosis Resource Site (Legionnaires' Disease and Pontiac Fever). Retrieved July 14, 2011, from http://www.cdc.gov/legionella/patient_facts.htm

33. Questions