Title: Prevalence of Latent Tuberculosis Infection in Type 2 Diabetic and Non-Diabetic Individuals
Authors: Kandasamy Venkatraju Rajalakshmi M.D, Viknesh Prabu Anbalagan MBBS
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.135
Abstract
Objective: To study the prevalence of latent tuberculosis infection (LTBI) between Asian Indian type 2 diabetic and non-diabetic individuals.
Methods: Participants with type 2 diabetes (n=98) and age and sex matched controls without diabetes (n=98) were recruited from Institute of Non Communicable diseases, Government Kilpauk medical College, Chennai. LTBI was defined as in duration of ≥10mm after Tuberculin Skin Test (TST) and with no abnormality in Chest X-ray based on WHO 2015 guidelines and Center for Disease control and prevention (CDC, USA) guideline. Type 2 Diabetes Mellitus (T2DM) was defined based on WHO criteria. Biochemical and anthropometric measurements were done using standardized procedures.
Results: The 196 participants included 102 women (44.9%). Mean age was 41 ± 9 .4 years and mean body mass index (BMI), 26.32 ± 4 kg/m². The prevalence of LTBI among diabetic and non-diabetic individuals were 35.7% and 12.2 %, respectively (p ≤ 0.001). The mean Tuberculin skin test (TST) In duration values were significantly higher in diabetic, (7.18 ± 3.0 mm) compared to non-diabetic, participants (5.58 ± 3.05 mm, p= 0.002).
Conclusion: Prevalence of Latent Tuberculosis Infection is higher among Asian Indian type 2 diabetic subjects compared to age and sex matched non-diabetic participants.
Keywords: Diabetes, Latent Tuberculosis, Tuberculin Skin Test, Tuberculosis, Asian Indians, South Asians
Abbreviations: LTBI Latent Tuberculosis Infection, T2DM type 2 Diabetes Mellitus, BMI - Body mass index, TST Tuberculin Skin Test.
References
1. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha Unnikrishnan R, Bhansali A,etal; ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec;54(12):3022-7. doi: 10.1007/s00125-011-2291-5. Epub 2011 Sep 30. PubMed PMID: 21959957.
2. World Health Organization . WHO Report 2011: Global Tuberculosis Control. World Health Organization website. http://www.who.int/tb/publications/global_report/2011/gtbr11_main.pdf.Accessed May 27, 2012.
3. Kornfeld H, West K, Kane K, Kumpatla S, Zacharias RR, Martinez- Balzano C, Li W, Viswanathan V. High Prevalence and Heterogeneity of Diabetes in Patients With TB in South India: A Report from the Effects of Diabetes on Tuberculosis Severity (EDOTS) Study. Chest. 2016 Jun;149(6):1501-8. doi: 10.1016/j.chest.2016.02.675. Epub 2016 Mar 10. PubMed PMID: 26973015; PubMed Central PMCID: PMC4944775.
4. Whitaker JA, Mirtskhulava V, Kipiani M, Harris DA, Tabagari N, Kempker RR, et al. Prevalence and incidence of latent tuberculosis infection in Georgian healthcare workers. PLoS ONE. 2013;8(3):8.
5. Kayanja HK, Debanne S, King C, Whalen CC. Tuberculosis infection among health care workers in Kampala, Uganda. Int J Tuberc Lung Dis. 2005;9 (6):686–8.
6. Joshi R, Reingold AL, Menzies D, Pai M. Tuberculosis among health-care workers in Low- and middle-income countries: a systematic review. PLoS Med. 2006;3(12)):2376–91.
7. Margolis B, Al-Darraji HAA, Wickersham JA, Kamarulzaman A, Altice FL. Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia. Int J Tuberc Lung Dis. 2013;17(12):1538–44.
8. Rafiza S, Rampal KG, Tahir A. Prevalence and risk factors of latent tuberculosis infection among health care workers in Malaysia. BMC Infect Dis. 2011;11:19.
9. Zhang X, Jia H, Liu F, Pan L, Xing A, Gu S, et al. Prevalence and risk factors for latent tuberculosis infection among health care workers in China: a cross-sectional study. PLoS ONE.2013;8(6):e66412-e.
10. Targeted tuberculin testing and treatment of latent tuberculosis infection: This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999: This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC): This statement was endorsed by the Council of the Infectious Diseases Society of America (IDSA), September 1999, and the sections of thisstatement. Am J Respir Crit Care Med. 2000;161:S221–47
11. Martínez-Aguilar G, Serrano CJ, Castañeda-Delgado JE, Macías- Segura N,Hernández-Delgadillo N, Enciso-Moreno L, García de Lira Y, Valenzuela-Méndez E et al Associated Risk Factors for Latent Tuberculosis Infection in Subjects with Diabetes. Arch MedRes. 2015 Apr;46(3):221-7. doi: 10.1016/j.arcmed.2015.03.009. Epub 2015 Apr 10. PubMedPMID: 25864989.
12. Vega Torres RA, Conde JG, Diaz M. Prevalence of tuberculin reactivity and risk factors for the development of active tuberculosis upon admission to a nursing home. P R Health Sci J1996;15:275e277.
13. Leow MK, Dalan R, Chee CB, et al. Latent tuberculosis in patients with diabetes mellitus: prevalence, progression and public health implications. Exp Clin Endocrinol Diabetes 2014;122:528e532.
14. Kumar NP, George PJ, Kumaran P, et al. Diminished systemic and antigen-specific type 1, type 17, and other proinflammatory cytokines in diabetic and prediabetic individuals with latent Mycobacterium tuberculosis infection. J Infect Dis 2014;210:1670e1678.
15. Whalen CC, Zalwango S, Chiunda A, Malone L, Eisenach K, Joloba M, et al.Secondary attack rate of tuberculosis in urban households in Kampala, Uganda. PLoS One. 2011;6(2):e16137.
16. Tornee S, Kaewkungwal J, Fungladda W, Silachamroon U, Akarasewi P,Sunakorn P. Risk factors for tuberculosis infection among householdcontacts in Bangkok, Thailand. Southeast Asian J Trop Med Public Health.2004;35:375–83.
17. Narain R, Nair S, Rao G, Chandrasekhar P. Distribution of tuberculous infection and disease among households in a rural community. Bull WorldHealth Organ. 1966;34:639–54
18. Rieder HL. Contacts of tuberculosis patients in high-incidence countries. IntJ Tuberc Lung Dis. 2003;7(12):S333–6.
19. Morrison J, Pai M, Philip J, Hopewell C. Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2008;8:259–68.
20. Madico G, Gilman RH, Cabrera L, Kacena K, Díaz JF, Gilman RH, et al. Community infection ratio as an indicator for tuberc-ulosis control. Lancet. 1995;345 (8947): 416–9.
21. Kayanja HK, Debanne S, King C, Whalen CC. Tuberculosis infection among health care workers in Kampala, Uganda. Int J Tuberc Lung Dis. 2005;9 (6):686–8
22. Joshi R, Reingold AL, Menzies D, Pai M. Tuberculosis among health-care workers in Low- and middle-income countries: a systematic review. PLoS Med. 2006;3 (12)):2376–91.
23. Margolis B, Al-Darraji HAA, Wickersham JA, Kamarulzaman A, Altice FL. Preval-ence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia. Int J Tuberc Lung Dis
24. Hanifa Y, Grant AD, Lewis J, Corbett EL, Fielding K, Churchyard G. Prevalence of latent tuberculosis infection among gold miners in South Africa. Int J Tuberc Lung Dis. 2009;13(1):39–46.
25. Durando P, Sotgiu G, Spigno F, Piccinini M, Mazzarello G, Viscoli C, et al. Latent tuberculosis infection and associated risk factors among undergraduate healthcare students in Italy: a cross-sectional study. BMC Infect Dis. 2013;13:443. doi: 10.1186/1471-2334-13-443
26. Baussano I, Williams BG, Nunn P, Beg-giato M, Fedeli U, Scano F. Tuberculosis incidence in prisons: a systematic review. PLoS Med 2010; 7(12): e1000381.
27. Dorman SE, Belknap R, Graviss EA, et al. Interferon-γ release assays and tuberculin skin testing for diagnosis of latent tuberculosis infection in healthcare workers in the United States. Am J Respir Crit Care Med 2014; 189: 77-87.