Current issues in the management of tuberculosis in Europe

Tuberculosis is a rare disease in Europe, so that most medical doctors never see a case and, although they know that the disease exists, they usually do not include it among the differential diagnosis of many respiratory or general disorders. Why is it, therefore, still important to speak about TB? This paper analysis some reasons: 1) TB is rare but has not disappeared. In Europe, some 400,000 cases are registered each year, with a slight decreasing tendency over the last few years but great disparities between countries and regions; 2) TB is more frequent in some risk groups, particularly among patients born in a country with a high incidence of disease or in persons exposed to the contact with TB, like close relatives of infectious patients. In EU/EEA, the majority of TB cases are observed among foreign-born persons; 3) if infected, some persons have a higher risk to develop TB. Small children and persons with viral or drug-induced immunosuppression (for instance anti-TNF) must be screened and protected if infected; 4) cases of TB among migrants generally occur after the entry in the country, from reactivation of latent TB acquired before. The border screening does not offer a garantee that the disease has been detected. Due attention to incurring symptoms and easy access to care must be maintained during the whole stay in the country for all foreign-born persons; 5) one of the major threats for the future is the progressive increase in the number of cases resistant to first-line drugs (Multidrug-resistant TB or MDR-TB) in several regions of the world, particularly in Eastern Europe; 6) due to decreasing knowledge and experience with the diagnosis and management of TB, many cases are diagnosed at a late stage. Medical doctors are encouraged to share their questions with experts and refer to existing Guidelines.