How much is too much alcohol in tuberculosis?

Abstract

About one third of the population worldwide have M. tuberculosis infections, although 90% of infected individuals never develop clinical disease 1,2 . The association between alcohol consumption and TB is well known 3,4 . Individuals who consume alcohol are considered immune-compromised because they have a greater incidence and severity of infectious diseases than abstainers, and are also more susceptible to lung infections such as TB and pneumonia 4 . In fact alcohol users are a group at high risk for TB who should be addressed accordingly with targeted preventative interventions 5,6 . In the present paper, we tried to determine the threshold of alcohol consumption that increased the risk for active TB in men and women.Cases and controls were recruited from primary health care units in the same geographical region. Pregnant or lactating women, and individuals infected with HIV or other immunosuppressive conditions were excluded. Cases were patients with active pulmonary TB (with or without pleural involvement), more than 18 years-old, and diagnosed with TB at outpatient centers in northern Portugal between August 2013 and September 2015. Controls were healthy individuals older than 18 years-old with no suspicion of active TB or history of TB in the participant's household within the previous 5 years.Registered data included daily alcohol consumption over the previous year (including types of beverages and the quantity consumed), age, sex, area of residence, nationality, and current occupation/employment status. The clinical data included co-morbidities (diabetes, chronic kidney disease, rheumatologic diseases, solid and hematologic cancers, lung disease, silicosis, heart and liver conditions, and history of TB) and other risk factors for TB infection (drug abuse, imprisonment, homelessness, or residence in a community shelter). This project was approved by Portugal's Northern Region Health Administration Ethics Committee, and all participants provided written informed consent. We performed separate analyses of men and women in the present study given the fact that the impact of ethanol is different in the two genders 7 . The crude effect of each evaluated variable on TB infection was investigated by simple logistic regression, except for variables associated with very low numbers of TB infections. Variables that were statistically significant were then included in a multiple binary logistic regression model. The selection of the best model was based on the likelihood-ratio test whenever possible, and otherwise on the Akaike Information Criterion (AIC). The model discriminability was as the AUROC curve. All statistical analyses were performed with R software (version 2.12.1). The level of significance was set at 0.05.We enrolled 289 subjects in this study, 50.5% of whom were male. The mean age (± SD, range) was 51.6 years-old (± 16.9, range: 19 to 87) for men and 50.9 years-old (± 17.2, range: 19 to 85) for women.

Diagnostic performances of the Xpert MTB/RIF in Brazil

“…Interestingly, while different studies were able to describe association between alcohol abuse and TB [17][18][19], we are the first to describe the relationship between alcohol abuse and Xpert performances.…”

Association of Leukotriene A4 Hydrolase with Tuberculosis Susceptibility Using Genomic Data in Portugal

“…The list of covariates in the TB patients and control group is shown in Table 1. Some of the individual covariates are significantly different between groups and, in general, the TB group includes a significantly higher number of males (p < 0.00001), younger individuals (p < 0.00001), and proportion of addictions (p = 0.00026), but was not significantly different for co-morbidities in general (p = 0.05480), most of them reflecting general trends for TB infection in the wider Portuguese population [11]. The refinement of the analysis with covariates did not reveal any significant difference in SNP proportions (Figure 1b).…”

Migration Flow and Its Impact on Tuberculosis Notification in Portugal

“…Apart from HIV infection, poor living and working conditions, which can facilitate TB transmission and risk factors that impair host's defense, like malnutrition, smoking, diabetes, alcohol abuse and indoor air pollution have been pointed out as major determinants. 29,30,31,32 Silicosis also increases the risk of TB by 2.8-39 times. 33,34 Silico-TB can be a challenging diagnosis and treatment must be longer.…”