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©2013 UpToDate ® Print Email Risk factors for the development of active tuberculosis among persons infected with Mycobacterium tuberculosis Risk factor Estimated risk for TB relative to persons with no known risk factor References High risk Acquired immunodeficiency syndrome (AIDS) 110-170 1,2 Human immunodeficiency virus infection (HIV) 50-110 3,4 Transplantation (related to immune-suppressant therapy) 20-74 5-8 Silicosis 30 9,10 Chronic renal failure requiring hemodialysis 10-25 11-14 Carcinoma of head and neck 16.0 15 Recent TB infection (≤2 years) 15.0 16,17 Abnormal chest x-ray with apical fibronodular changes typical of healed TB (not granuloma) 6-19 18-20 Tumor necrosis factor (TNF)-alpha inhibitors 1.7-9 21,22,35,36 Moderate risk Treatment with glucocorticoids 4.9 23 Diabetes mellitus (all types) 2-3.6 24-27 Young age when infected (≤4 years) 2.2-5 28 Slightly increased risk Underweight (<85 percent of ideal body weight); for most individuals this is equivalent to body mass index (BMI) ≤20. 2-3 29 Cigarette smoker (1 pack/day) 2-3 30,31 Chest x-ray with solitary granuloma 2 20,32 Low risk Infected person, no known risk factor, normal chest x-ray ("low risk reactor") 1 33 Very low risk Positive booster (two step test) with no other known risk factor and normal chest x-ray) 0.5 Extrapolated from 33 and 34

Underweight (<85 percent of ideal body weight); for most individuals this is equivalent to body mass index (BMI) ≤20. 2-3 29 Cigarette smoker (1 pack/day) 2-3 30,31 Chest x-ray with solitary granuloma 2 20,32 Low risk Infected person, no known risk factor, normal chest x-ray ("low risk reactor") 1 33 Very low risk Positive booster (two step test) with no other known risk factor and normal chest x-ray) 0.5 Extrapolated from 33 and 34 1.  Guelar, A., J. M. Gatell, J. Verdejo, D. Podzamczer, L. Lozano, E. Aznar, J. M. Miro, J. Mallolas, L. Zamora, J. Gonzales, and E. Soriano. 1993. A prospective study of the risk of tuberculosis among HIV-infected patients. AIDS 7:1345-1349. 2.  Antonucci, G., E. Girardi, M. C. Raviglione, G. Ippolito, and for the GISTA. 1995. Risk factors for tuberculosis in HIV-infected persons. A prospective cohort study. JAMA 274:143-148. 3.  Wood R, Maartens G, and Lombard CJ. 2000. Risk factors for developing tuberculosis in HIV-1 - Infected adults from communities with low or very high incidence of tuberculosis. J Acquir Immune Defic Syndr 23:75-80. 4.  Selwyn PA, Hartel D, Lewis VA, Schoenbaum EE, Vermund SH, Klein RS, Walker AT, and Friedland GH. 1989. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. New Engl J Med 320:545-550. 5.  Sakhuja, V., V. Jha, P. P. Varma, K. Joshi, and K. S. Chugh. 1996. The high incidence of tuberculosis among renal transplant recipients in India. Transplantation 61:211-215. 6.  Aguado, J. M., J. A. Herrero, J. Gavalda, J. Torre-Cisneros, M. Blanes, G. Rufi, A. Moreno, M. Gurgui, M. Hayek, C. Lumbreras, and C. Cantarell. 1997. Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Spanish Transplantation Infection Study Group, GESITRA. Transplantation 63:1278-1286. 7.  Miller, R. A., L. A. Lanza, J. N. Kline, and L. J. Geist. 1995. Mycobacterium tuberculosis in lung transplant recipients. Am J Respir Crit Care Med 152:374-376. 8.  Meyers, B. R., M. Halpern, P. Sheiner, M. H. Mendelson, E. Neibart, and C. Miller. 1994. Tuberculosis in liver transplant patients. Transplantation 58:301-306. 9.  Hong Kong Chest Service Tuberculosis Research Centre, M. B. M. R. C. 1992. A Double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Am Rev Respir Dis 145:36-41. 10. Cowie, R. L. 1994. The epidemiology of tuberculosis in gold miners with silicosis. Am J Respir Crit Care Med 150:1460-1462. 11. Malhotra, K. K., M. K. Parashar, R. K. Sharma, U. N. Bhuyan, S. C. Dash, R. Kumar, and D. S. Rana. 1981. Tuberculosis in maintenance haemodialysis patients. Study from an endemic area. Postgrad.Med J 57:492-498. 12. Lundin, A. P., A. J. Adler, G. M. Berlyne, and E. A. Friedman. 1979. Tuberculosis in patients undergoing maintenance hemodialysis. Am J Med 67:597-602. 13. Andrew, O. T., P. Y. Schoenfeld, P. C. Hopewell, and M. H. Humphreys. 1980. Tuberculosis in patients with end-stage renal disease. Am J Med 68:59-65. 14. Pradhan, R. P., L. A. Katz, B. D. Nidus, R. Matalon, and R. P. Eisinger. 1974. Tuberculosis in dialyzed patients. JAMA 229:798-800. 15. Rieder, H. L., G. M. Cauthen, G. W. Comstock, and D. E. Snider, Jr. 1989. Epidemiology of tuberculosis in the United States. Epidemiol.Rev. 11:79-98. 16. Sutherland I. 1976. Recent studies in the epidemiology of tuberculosis, based on the risk of being infected with tubercle bacilli. Adv Tuberc Res 19:1-63. 17. Sutherland, I. 1966. The evolution of clinical tuberculosis in adolescents. Tuberc 47:308. 18. Nolan CM and Elarth AM. 1988. Tuberculosis in a cohort of Southeast Asian refugees: A five-year surveillance study. Am Rev Resp Dis 137:805-809. 19. Grzybowksi, S., N. E. McKinnon, L. Tuters, G. Pinkus, and R. Philipps. 1966. Reactivations in inactive pulmonary tuberculosis. Am Rev Resp Dis 93:352-360. 20. Grzybowski, S., H. Fishaut, J. Rowe, and A. Brown. 1971. Tuberculosis among patients with various radiologic abnormalities, followed by the chest clinic service. Am Rev Resp Dis 104:605-608. 21. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, and Braun MM. 2001. Tuberculosis associated with infliximab, a tumor necrosis factor ? - neutralizing agent. The New England Journal of Medicine 345:1098-1104. 22. Brassard, P., A. Kezouh, and S. Suissa. 2006. Antirheumatic drugs and the risk of tuberculosis. Clin.Infect.Dis 43:717-722. 23. Jick, S. S., E. S. Lieberman, M. U. Rahman, and H. K. Choi. 2006. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 55:19-26. 24. Kim, S. J., Y. P. Hong, W. J. Lew, S. C. Yang, and E. G. Lee. 1995. Incidence of pulmonary tuberculosis among diabetics. Tuber.Lung Dis. 76:529-533. 25. Silwer H. and Oscarsson P.N. 1958. Incidence and coincidence of diabetes mellitus and pulmonary tuberculosis in a Swedish county. Acta Med Scand. 161:1-48. 26. Pablos-Mendez, A., J. Blustein, and C. A. Knirsch. 1997. The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. Am J Public Health 87:574-579. 27. Boucot KR. 1957. Diabetes mellitus and pulmonary tuberculosis. J Chronic.Dis 6:256-279. 28. Comstock, G. W., V. T. Livesay, and S. F. Woolpert. 1974. The prognosis of a positive tuberculin reaction in childhood and adolescence. American Journal of Epidemiology. 99:131-137. 29. Comstock GW. 1975. Frost Revisited: The modern epidemiology of tuberculosis. Am J Epidemiology 101:263-382. 30. Maurya, V., V. K. Vijayan, and A. Shah. 2002. Smoking and tuberculosis: an association overlooked. Int.J Tuberc.Lung Dis. 6:942-951. 31. Gajalakshmi V, Peto R, Kanaka T, and Jha P. Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls. The Lancet 362, 507. 2003. Ref Type: Journal (Full) 32. Horwitz, O., E. Wilbek, and P. A. Erickson. 1969. Epidemiological basis of tubeculosis eradication. Longitudinal studies on the risk of tuberculosis in the general population of a low-prevalence area. Bull.Wld Hlth Org. 41:95-113. 33. Comstock GW, Edwards LB, and Livesay VT. 1974. Tuberculosis morbidity in the US Navy: its distribution and decline. Am Rev Respir Dis 110:572-580. 34. Ferebee SH. 1969. Controlled chemoprophylaxis trials in tuberculosis. Adv Tuberc Res 17:28-106. 35. Wolfe F, Michaud K, Anderson J, et al. Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum. 2004 Feb;50(2):372-9. 36. Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum. 2005 Jun;52(6):1766-72.