Screening of latent tuberculosis infection among patients with diabetes mellitus from a high-burden area in Brazil

Amanda Vital Torres; Raquel da Silva Corrêa; Maria de Fátima Bevilacqua; Luana Cristina França do Prado; Flavia Miranda Gomes de Constantino Bandeira; Luciana Silva Rodrigues; Marilia Brito Gomes

doi:10.3389/fcdhc.2022.914574

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. eCollection 2022.

Authors

Amanda Vital Torres^{1

2}, Raquel da Silva Corrêa², Maria de Fátima Bevilacqua¹, Luana Cristina França do Prado², Flavia Miranda Gomes de Constantino Bandeira^{3

4}, Luciana Silva Rodrigues², Marilia Brito Gomes¹

Affiliations

¹ Diabetes Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.
² Laboratory of Immunopathology, Department of Pathology and Laboratories, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.
³ Hematology and Transfusion Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.
⁴ Herbert de Souza Hemotherapy Service, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil.

Abstract

Although several cohort studies have raised the important association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI), evidences are limited and controversial. Furthermore, it is well documented that the poor glycemic control may exacerbate the risk for active TB. Thus, the monitoring of diabetic patients living in high-incidence areas for TB is an important concern in views of available diagnostic tests for LTBI. In this cross-sectional study, we estimate the association of DM and LTBI among diabetic patients classified as type-1 DM (T1D) or type-2 DM (T2D) living in Rio de Janeiro, RJ, Brazil - considered a high TB burden region of these country. Non-DM volunteers were included as endemic area healthy controls. All participants were screened for DM using glycosylated-hemoglobin (HbA_1c) and for LTBI using the QuantiFERON-TB Gold in Tube (QFT-GIT). Demographic, socioeconomic, clinical and laboratorial data were also assessed. Among 553 included participants, 88 (15.9%) had QFT-GIT positive test, of which 18 (20.5%) were non-DM, 30 (34.1%) T1D and 40 (45.4%) T2D. After adjustments for potential baseline confounders, age, self-reported non-white skin color and an active TB case in the family were significantly associated with LTBI among the studied population by using a hierarchical multivariate logistic regression analysis. Additionally, we verified that T2D patients were able to produce significant increased interferon-gamma (IFN-γ) plasma levels in response to Mycobacterium tuberculosis-specific antigens, when compared to non-DM individuals. Altogether, our data showed an increased prevalence of LTBI among DM patients, albeit non-statistically significant, and point out to important independent factors associated with LTBI, which deserve attention in monitoring patients with DM. Moreover, QFT-GIT test seems to be a good tool to screening LTBI in this population, even in a high TB burden area.

Keywords: QuantiFERON-TB gold in tube; diabetes; diabetes mellitus; interferon-gamma release assay; latent tuberculosis infection; tuberculosis.