Smoking and tuberculosis: the epidemiological association and immunopathogenesis

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 100; no. 4; pp. 291 - 298
• Main Authors: Davies, P.D.O., Yew, W.W., Ganguly, D., Davidow, A.L., Reichman, L.B., Dheda, K., Rook, G.A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2006; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Adolescent; Adult; Aged; Alcohol Drinking - epidemiology; Bacterial diseases; Biological and medical sciences; Child; China - epidemiology; Epidemiology; Female; Human bacterial diseases; Humans; Immunopathology; India - epidemiology; Infectious diseases; Macrophages; Macrophages, Alveolar - drug effects; Male; Medical sciences; Middle Aged; Nicotine - pharmacology; Risk Factors; Smoking; Smoking - adverse effects; Smoking - epidemiology; TNF-α; Tobacco, tobacco smoking; Toxicology; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - etiology; Tuberculosis, Pulmonary - physiopathology; Tumor Necrosis Factor-alpha - metabolism; United Kingdom - epidemiology; United States - epidemiology; Immunopathology; Tuberculosis; TNF-α; Macrophages; Epidemiology; Smoking; Human; TNF-a; Respiratory disease; Tobacco smoking; Mycobacterial infection; Review; Infection; Association; Tumor necrosis factor; Bacteriosis; Macrophage
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/j.trstmh.2005.06.034

There is increasing evidence of a link between tuberculosis and smoking. This paper reviews the epidemiological evidence from the UK, China, India and the USA, summarizing some of the main papers which indicate an association. Where an association has been found there seems to be an increase in tuberculosis case rates of between two- and four-fold for those smoking in excess of 20 cigarettes a day, but it may be difficult to control for other factors, particularly alcohol consumption. The final part of the paper reviews possible mechanisms. A likely possibility is that nicotine turns off the production of TNF-α by the macrophages in the lungs, rendering the patient more susceptible to the development of progressive disease from latent Mycobacterium tuberculosis infection.