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The majority of these patients were male and were younger, quite transversal to all TB patients, and not different from the MDR-TB ones. In European prisons, there is 17 times higher frequency of TB compared with the general population, being higher in Western Europe. Risk factors for TB outbreaks in prisons are late diagnosis, inappropriate treatment, overcrowding, HIV coinfection, illegal immigrants and drug addiction. Homeless, unemployment, alcoholism, drug addiction and difficulty in complying with TB therapy were stated as major barriers to completion of TB treatment among prisoners, therefore potentially contributing to the emergence of XDR-TB [36]. However, to the best of our knowledge, there are no data on the prevalence of XDR-TB in prisons, although in specific settings this may contribute to a higher risk of developing XDR-TB [19]. Immigrants may face particular barriers to timely access health-care services; Fleroxacin therefore, they may have higher chances of developing TB. The risk of TB decreases since the entry in the new country but remains higher than general population [21]. Luminespib supplier In many studies, a great proportion of XDR-TB patients were immigrants, and in such cases it imposes a reactivation of latent TB, although the true risk for developing XDR has not been established. In many studies, diabetes mellitus was an important condition associated with TB. Although some authors say that this could result in higher susceptibility to the infection of resistant strains, the true mechanisms are not known [37]. Other conditions, such as homelessness, drug and alcohol abuse, and unemployment, may be important, not directly, but involved through HIV coinfection or contributing to the failure of previous TB treatment. However, such conditions are not accessed in the majority of the studies. Africa is facing the worst TB epidemics [3, 7], with HIV being attributed as the major risk factor, by reactivating latent TB by 100-fold or because of immunosuppression-promoting Selleck RO4929097 TB infection. It would be expected higher proportions of HIV coinfection in these studies, attending to HIV prevalence in those countries. However, in some studies all patients were HIV positive [10, 26]. In one study, patients with HIV coinfection had worse 1-year mortality (83%) and 30-day mortality (956 deaths per 100 patient-years) rates, with higher degree of drug resistance (P?