Free Content Tuberculosis skin testing, anergy and protein malnutrition in Peru

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Abstract:

SETTING: Malnutrition and intestinal parasites cause immunosuppression. This may cause false-negative tuberculin skin tests (TST) and failure to identify tuberculosis (TB) infection.

OBJECTIVE: To assess factors associated with TST positivity and anergy in disadvantaged communities in Peru.

DESIGN: A study of 212 randomly selected adults: 102 in a rural Amazonian village and 110 shanty town residents in urban Lima.

RESULTS: Respectively 52% and 53% of urban and rural jungle populations were TST-positive. Using simultaneous tetanus and candida skin tests, 99% had at least one positive skin test. Generalised anergy was therefore rare, despite frequent intestinal parasitic infection, including 34% helminth infection prevalence in the jungle. TST positivity was associated with age (P = 0.001), known TB contact (P = 0.02) and poor household ventilation (P = 0.007). TST positivity was not significantly associated with crowding, reported past TB, single/multiple BCG vaccination, income, intestinal parasites, dietary factors, body mass index or body fat. Individuals with lower anthropometric body protein, as measured by corrected arm muscle area, were less likely to be TST-positive (P = 0.02), implying that protein malnutrition caused tuberculin-specific anergy.

CONCLUSION: These results identify the importance of household ventilation for community TB transmission and add to the evidence that protein malnutrition suppresses TB immunity, causing false-negative TST results.

Keywords: TST; anergy; anthropometry; protein malnutrition; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Asociación Benéfica PRISMA, Lima, Peru 2: Ministry of Health, Iquitos, Loreto, Peru 3: Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru 4: Asociación Benéfica PRISMA, Lima, Peru; and Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, United Kingdom

Publication date: September 1, 2005

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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