PREVALENCE OF LATENT TUBERCULOSIS INFECTION (LTBI) IN PATIENTS WITH DIABETES MELLITUS
Main Article Content
Keywords
Diabetic, Diabetes Mellitus, Latent Tuberculosis Infection, Prevalence, Tuberculosis
Abstract
Objectives: To determine the prevalence of Latent Tuberculosis Infection (LTBI) in diabetic patients.
Study Design: A descriptive cross - sectional study.
Settings: Pulmonology Department, Fauji Foundation Hospital Rawalpindi
Period: 06 months - 1st Jan 2021 to 1st July 2021.
Material & Methods: After approval by the Ethical Review Committee, Fauji Foundation Hospital Rawalpindi, a cross-sectional study was carried out. Non-probability consecutive sampling technique was used. After obtaining informed consent, around 100 Diabetic patients, both previously and newly diagnosed were enrolled in the study. The study participants were screened for Latent TB infection using chest radiography and the interferon-gamma release assay Quantiferon-TB Gold In-Tube Test (QFT-GIT) and classified according to CDC (Center for Disease Control and Prevention) guidelines. Data regarding age, gender, HbA1c were also collected.
Results: Out of 100 diabetic patients (mean age: 55.77 ± 12.30 years), of whom majority (93%) were females; 45% of the cases presented with Latent Tuberculosis Infection (LTBI). Chi square test of independence revealed an association of duration of Diabetes Mellitus with Latent TB Infection i.e. 34 (40%) patients who had diabetes for more than 12 months had LTBI; compared to 11 (73.3%) of the patients with DM duration less than 12 months (p - value = 0.025).
Conclusion: A substantial number of LTBI cases were detected in the diabetic population via the Quantiferon Gold TB test, highlighting the need to integrate TB infection management in diabetes care.
References
2. Sieniawska, E. (2024).Recent research progress in the plant contribution to the management of tuberculosis. eFood,5(3), e157. DOI: https://doi.org/10.1002/efd2.157
3. Lv, H., Wang, L., Zhang, X. et al. Further analysis of tuberculosis in eight high-burden countries based on the Global Burden of Disease Study 2021 data. Infect Dis Poverty 13, 70 (2024). DOI: https://doi.org/10.1186/s40249-024-01247-8
4. Waheed MS. Tuberculosis. World Health Organization - Regional Office for the Eastern Mediterranean. 2023. URL: https://www.emro.who.int/pak/programmes/stop-tuberculosis.html
5. Majeed AI, Pandit RK. Tuberculosis (TB) Tsunami in Pakistan. 2024 Jun 5; URL: https://www.preprints.org/manuscript/202406.0222/v1
6. Ding C, Hu M, Guo W, Hu W, Li X, Wang S, et al. Prevalence trends of latent tuberculosis infection at the global, regional, and country levels from 1990–2019. Int J Infect Dis. 2022 Sep;122:46-62. DOI: 10.1016/j.ijid.2022.05.029.
7. CDC. Deciding When to Treat Latent TB Infection. CDC. 2019. URL: https://www.cdc.gov/tb/topic/treatment/decideltbi.htm
8. Zafar, Mubashir. Prevelence of latent tuberculosis and associated risk factors in children under 5 years of age in Karachi, Pakistan. The Journal of Association of Chest Physicians 2(1):p 16-24, Jan–Jun 2014. | DOI: 10.4103/2320-8775.126504)
9. Fatima, K., Zaheer, R., Sohail, Z. and Shakeel, M.-u. (2025). Prevalence of latent tuberculosis infection and identification of associated risk factors in overcrowded Central Prison Rawalpindi, Pakistan; International Journal of Prison Health; 21(2) 156-175. DOI: https://doi.org/10.1108/IJOPH-09-2020-0067
10. Sadaf R, Munir T, Farrukh S, Abbasi S. Prevalence of latent tuberculosis infection in healthcare workers in tertiary care hospitals of Pakistan. Pak J Med Sci. 2020 Jan-Feb;36(2):198-202. DOI: 10.12669/pjms.36.2.936.
11. World Health Organization. The top 10 causes of death. World Health Organization. 2024. URL: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
12. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022 Jan 1;183:109119. DOI: 10.1016/j.diabres.2021.109119
13. Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). 2022 JuN 3; 79:103901. DOI: 10.1016/j.amsu.2022.103901
14. Ahmed J, Bijrani SA, Ikram T, Ali MS, Huma S, Saeed U. Knowledge, Attitudes and Practices about determinants of Diabetes among Non-Diabetic Pakistanis. MJCMH 2024 Dec 5; 6(2). DOI: https://doi.org/10.61982/medera.v6i2.164
15. Martinez N, Kornfeld H. Diabetes and immunity to tuberculosis. Eur J Immunol. 2014 Mar;44(3):617-26. DOI: 10.1002/eji.201344301.
16. Gonzalez-Curiel I, Castañeda-Delgado J, Lopez-Lopez N, Araujo Z, Hernandez-Pando R, Gandara-Jasso B, et al. Differential expression of antimicrobial peptides in active and latent tuberculosis and its relationship with diabetes mellitus. Hum Immunol. 2011 Aug;72(8):656-62. DOI: 10.1016/j.humimm.2011.03.027.
17. Ayelign B, Negash M, Genetu M, Wondmagegn T, Shibabaw T. Immunological Impacts of Diabetes on the Susceptibility of Mycobacterium tuberculosis. J Immunol Res. 2019 Jan;2019(1) 1-8:6196532. DOI: https://doi.org/10.1155/2019/6196532
18. WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization; 2018. URL: https://pubmed.ncbi.nlm.nih.gov/30277688/ PMID: 30277688
19. Barnes PF. Weighing gold or counting spots: which is more sensitive to diagnose latent tuberculosis infection? Am J Respir Crit Care Med. 2006 Oct 1;174(7):731-2. DOI: 10.1164/rccm.200607-907ED.
20. Choi Y, Kim IK, Kim SJ, Kim HS, Kang YA, Song JS. Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis. PLOS ONE. 2024 May 9;19(5):e0303050. DOI: https://doi.org/10.1371/journal.pone.0303050
21. Hensel RL, Kempker RR, Tapia J, Oladele A, Blumberg HM, Magee MJ. Increased risk of latent tuberculous infection among persons with pre-diabetes and diabetes mellitus. Int J Tuberc Lung Dis. 2016 Jan;20(1):71-8. DOI: 10.5588/ijtld.15.0457
22. Sultana I, Masood SM, Meraj L, Shahzad A, Zulfiqar A. Frequency of Latent Tuberculosis among Diabetics and Non-Diabetics. Journal of Islamic International Medical College (JIIMC). 2012 Dec 3;7(2):72–5. URL: https://journals.riphah.edu.pk/index.php/jiimc/article/view/775
23. Abbas U, Masood KI, Khan A, Irfan M, Saifullah N, Jamil B, et al. Tuberculosis and diabetes mellitus: Relating immune impact of co-morbidity with challenges in disease management in high burden countries. J Clin Tuberc Other Mycobact Dis. 2022 Dec 1;29:100343. DOI: https://doi.org/10.1016/j.jctube.2022.100343
24. Krishna S, Jacob JJ. Diabetes Mellitus and Tuberculosis. 2021 Apr 18. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al., editors. Endotext PubMed. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 33945243.
25. Jeon CY, Murray MB. Correction: Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies. PLOS Medicine 5(8):e181. DOI: https://doi.org/10.1371/journal.pmed.0050181
26. Stubbs B, Siddiqi K, Elsey H, Siddiqi N, Ma R, Romano E, et al. Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries. Int. J. Environ. Res. Public Health 2021, 18(5), 2439; DOI: https://doi.org/10.3390/ijerph18052439
27. Barron MM, Shaw KM, Bullard KM, Ali MK, Magee MJ. Diabetes is associated with increased prevalence of latent tuberculosis infection: Findings from the National Health and Nutrition Examination Survey, 2011-2012. Diabetes Res Clin Pract. 2018 May;139:366-379. DOI: 10.1016/j.diabres.2018.03.022.
28. Torres AV, Corrêa RDS, Bevilacqua MF, do Prado LCF, Bandeira FMGC, Rodrigues LS, et al. Screening of latent tuberculosis infection among patients with diabetes mellitus from a high-burden area in Brazil. Front Clin Diabetes Healthc. 2022 Aug 17;3:914574. DOI: 10.3389/fcdhc.2022.914574.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Amber Mazhar
Senior Registrar, Pulmonology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
Anila Rehman
Lecturer, Department of Community Medicine & Public Health, Foundation University Medical College, Islamabad, Pakistan
Rizwan Athar
Head of Department, Department of Pulmonology, Islamabad Medical Complex Hospital, NESCOM, Islamabad, Pakistan
Hira Vaqar
Senior Registrar, Pulmonology, HBS General Hospital, Islamabad, Pakistan
Hafiz Usman Ranjha
Senior Registrar, Pulmonology, Fauji Foundation Hospital / Foundation University School of Health Sciences, Rawalpindi, Pakistan
