TY - JOUR
T1 - Screening diabetes mellitus patients for pulmonary tuberculosis
T2 - A multisite study in Indonesia, Peru, Romania and South Africa
AU - TANDEM consortium
AU - Alisjahbana, Bachti
AU - Mcallister, Susan M.
AU - Ugarte-Gil, Cesar
AU - Panduru, Nicolae Mircea
AU - Ronacher, Katharina
AU - Koesoemadinata, Raspati C.
AU - Zubiate, Carlos
AU - Riza, Anca Lelia
AU - Malherbe, Stephanus T.
AU - Kleynhans, Leanie
AU - Lopez, Sonia
AU - Dockrell, Hazel M.
AU - Ruslami, Rovina
AU - Ioana, Mihai
AU - Walzl, Gerhard
AU - Pearson, Fiona
AU - Critchley, Julia A.
AU - Moore, David A.J.
AU - Van Crevel, Reinout
AU - Hill, Philip C.
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods: DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results: A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions: These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.
AB - Background: Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods: DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results: A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions: These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.
KW - diabetes mellitus
KW - screening
KW - tuberculosis
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U2 - 10.1093/trstmh/traa100
DO - 10.1093/trstmh/traa100
M3 - Article
C2 - 33118039
AN - SCOPUS:85107711694
SN - 0035-9203
VL - 115
SP - 634
EP - 643
JO - Transactions of the Royal Society of Tropical Medicine and Hygiene
JF - Transactions of the Royal Society of Tropical Medicine and Hygiene
IS - 6
ER -