High prevalence of Mycobacterium tuberculosis infection and disease in children and adolescents with type 1 diabetes mellitus

Authors: Webb, E.A.¹; Hesseling, A.C.²; Schaaf, H.S.²; Gie, R.P.²; Lombard, C.J.³; Spitaels, A.⁴; Delport, S.⁴; Marais, B.J.²; Donald, K.⁴; Hindmarsh, P.⁵; Beyers, N.²

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 7, July 2009 , pp. 868-874(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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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.
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Abstract:

SETTING: Western Cape Province, South Africa.

OBJECTIVES: To describe the prevalence of tuberculosis (TB) infection and disease in children with type 1 diabetes and to investigate the association between glycaemic control and prevalence of TB infection and disease.

DESIGN: Cross-sectional hospital-based study conducted at two public referral hospitals. All children and adolescents (aged <21 years) with type 1 diabetes underwent a Mantoux tuberculin skin test (≥10 mm classified as Mycobacterium tuberculosis infection), measurement of glycosylated haemoglobin and a chest radiograph. Patients with symptoms suggestive of TB were investigated using mycobacterial culture. Radiologically and/or bacteriologically confirmed disease was classified as TB disease.

RESULTS: Of 291 eligible patients, 258 (88.7%) were included (58% female). The prevalence of M. tuberculosis infection was 29.8% (95%CI 24.2-35.4); nine patients were diagnosed with prevalent TB disease (point prevalence disease 3488 per 100 000 population). Poor glycaemic control (hazard ratio 1.39, 95%CI 1.18-1.63 per unit increase in glycated haemoglobin [HbA1c]) and contact with a TB source case (P = 0.0011) was associated with prevalent TB disease.

CONCLUSIONS: There is a high prevalence of TB disease in diabetic children and adolescents in this setting. Routine TB screening of children with type 1 diabetes may be indicated in settings highly endemic for TB. Preventive treatment should be considered for diabetic children with proof of TB exposure and/or infection.

Keywords: childhood; tuberculosis; glycaemic control; diabetes

Document Type: Regular paper

Affiliations: 1: Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa; Department of Paediatric and Adolescent Endocrinology, Groote Schuur and Red Cross Children's Hospitals, University of Cape Town, Cape Town, South Africa 2: Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa 3: Biostatistics Unit, Medical Research Council, Tygerberg, South Africa 4: Department of Paediatric and Adolescent Endocrinology, Groote Schuur and Red Cross Children's Hospitals, University of Cape Town, Cape Town, South Africa 5: Department of Paediatric and Adolescent Endocrinology, Great Ormond Street Children's Hospital, London, United Kingdom