The changing epidemiology of spinal tuberculosis: the influence of international immigration in Catalonia, 1993-2014

The overall incidence of spinal tuberculosis (TB) appears to be stable or declining in most European countries, but with an increasing proportion of cases in the foreign-born populations. We performed a retrospective observational study (1993-2014), including all cases of spinal TB diagnosed at a Barcelona hospital to assess the epidemiological changes. Fifty-four episodes (48.1% males, median age 52 years) of spinal TB were diagnosed. The percentage of foreign-born residents with spinal TB increased from 14% to 45.2% in the last 10 years (P = 0.017). Positive Mycobacterium tuberculosis testing in vertebral specimens was 88.2% (15/17) for GeneXpert MTB/RIF. Compared with natives, foreign-born patients were younger (P<0.01) and required surgery more often (P = 0.003) because of higher percentages of paravertebral abscess (P = 0.038), cord compression (P = 0.05), and persistent neurological sequelae (P = 0.05). In our setting, one-third of spinal TB cases occurred in non-native residents. Compared with natives, foreign-born patients were younger and had greater severity of the disease. The GeneXpert MTB/RIF test may be of value for diagnosing spinal TB.