Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis

Campbell, Jonathon R.; Chen, Wenjia; Johnston, James C.; Cook, Victoria; Elwood, Kevin; Krot, Jane; Marra, Fawziah

doi:10.1007/s40291-015-0135-6

Cited by 32 publications

(20 citation statements)

References 62 publications

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“…We found the results of the TST and QFT-Plus tests to be in poor agreement (0.225), which is similar to what others have found [31,[33][34][35][36][37][38]. The accuracy measures of the TST are often confounded by BCG vaccination and non-tuberculous mycobacterial (NTM) infections [39], [14].…”

Section: Discussionsupporting

confidence: 75%

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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Background The World Health Organization (WHO) End Tuberculosis Strategy calls for a 90% reduction in tuberculosis (TB) deaths and an 80% reduction in the incidence rate between 2015 and 2035. The 2018 WHO guidelines recognize the need for high-burden countries to implement outreach and treatment for the most vulnerable patients with latent TB infection (LTBI) in addition to treating patients with the active disease. The Democratic Republic of Congo (DR Congo) is among the countries bearing the highest burden of TB. However, additional data on LTBI is required for effective policy and strategy against the disease. Accordingly, the aim of this study is to estimate the prevalence of LTBI in HIV-infected adults in Kinshasa, DR Congo. Methods Over two hundred HIV-infected adult residents of Kinshasa were screened using both TUBERTEST®, which is a tuberculin skin test (TST), and QuantiFERON-TB Gold Plus® (QFT-Plus), which is an interferon gamma release assay. LTBI was screened using TST, QFT-Plus, and a combination of the two tests. The agreement between TST and QFT-Plus was calculated using Cohen’s Kappa coefficient. Results A total of 248 HIV-infected persons were enrolled in the study. Seventy-six patients (30.7% IC 95%: 25.2-36.7) had a positive TST result. Sixty-four (25.8% IC 95%: 20.7-31.6) had a positive QFT-Plus test result. The Kappa coefficient between TST and QFT-Plus was 0.225. Conclusions The prevalence of LTBI among HIV positive adults in Kinshasa was high considering either the positive TST or the positive QFT-Plus. However, the two tests had poor agreement.

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Section: Discussionsupporting

confidence: 75%

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Kadima

Lutumba

Kaswa³

et al. 2019

Preprint

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“…11,12 Some patients have characteristics that put them at risk of acquiring TB. 1,8 Some factors recognized as risk factors for TB are smoking [19][20] , presence of any immunosuppression status (use of immunosuppressive drugs, cancer or HIV infection) 10,[21][22][23][24][25][26][27] , younger or older age 28,29 , migrant status [30][31][32] , inmate status 31,33 , homelessness or institutionalization 31,34,35 , close contact with TB-infected patients 36,37 , drug use 38 , alcoholism 39 , malnutrition 40 , diabetes [41][42] and other chronic comorbidities [43][44][45] . Obesity 46 and female gender 47 seem to reduce the risk of acquiring TB.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis in a Portuguese Cohort

Guerra-Maio¹,

Coutinho²,

Nunes³

et al. 2017

Gal. Clin.

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Background: Tuberculosis (TB) is a multisystemic disease and a leading cause of infectious disease-related mortality worldwide. Objectives: This study aims to characterize patients with TB in a portuguese cohort. Methods: Retrospective analysis of files pertaining inpatients with TB admitted between 1/2005 -12/2014. Data were analysed using χ2 or Fisher exact test (p<0.005 = statistically significant) and odds ratio was calculated. Results: 222 cases were found: 128 patients had pulmonary involvement (PTB) and 100 extrapulmonary disease (ETB) (6 had overlapping disease), with men being mostly affected. The most common locations of ETB were lymphatic (27.0%), meningeal and osteoarticular (both 19.0%). The majority exhibited risk factors (64.0%, p<0.005). PTB was associated with smoking (p=0.000, OR=5.05) and contact with TB-infected person (p=0.002, OR=7.53). Human immunodeficiency virus (HIV) infection (p=0.000, OR=5.16) and age > 65 (p=0.005, OR=3.34) were associated with ETB. 48 patients were HIV-infected, with median CD4 count of 74.5 cells/µL (13-136), most cases occurring in the setting of new HIV diagnosis. HIV infection was statistically associated with disseminated (OR=12.64), pleural (OR=8.50), meningeal (OR=2.96) and lymphatic TB (OR=2.38). HIV negativity was associated with pulmonary (OR=4.08) and osteoarticular disease (OR=5.42). PTB was confirmed mainly by culture or PCR test plus smear (81.3%). ETB diagnosis was more complex. Clinical outcome was favourable (PTB 98.4%; ETB 94.0%). Eight patients died. Conclusions: TB remains an important healthcare issue in Portugal. Contact with TB-infected person and smoking (PTB) and HIV infection and age > 65 (ETB), were significant risk factors. HIV infection was associated with disseminated, pleural, meningeal and lymphatic disease.

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“…Given the large proportion of foreign-born individuals with LTBI infection,2 widespread LTBI screening and treatment is unlikely to be practical or cost-effective 3–5. Instead, a strategy that focuses on people with highest TB risk should be considered 1…”

Section: Introductionmentioning

confidence: 99%

Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study

et al. 2016

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IntroductionImproved understanding of risk factors for developing active tuberculosis (TB) will better inform decisions about diagnostic testing and treatment for latent TB infection (LTBI) in migrant populations in low-incidence regions. We aim to examine TB risk factors among the foreign-born population in British Columbia (BC), Canada, and to create and validate a clinically relevant multivariate risk score to predict active TB.Methods and analysisThis retrospective population-based cohort study will include all foreign-born individuals who acquired permanent resident status in Canada between 1 January 1985 and 31 December 2013 and acquired healthcare coverage in BC at any point during this period. Multiple administrative databases and disease registries will be linked, including a National Immigration Database, BC Provincial Health Insurance Registration, physician billings, hospitalisations, drugs dispensed from community pharmacies, vital statistics, HIV testing and notifications, cancer, chronic kidney disease and dialysis treatment, and all TB and LTBI testing and treatment data in BC. Extended proportional hazards regression will be used to estimate risk factors for TB and to create a prognostic TB risk score.Ethics and disseminationEthical approval for this study has been obtained from the University of British Columbia Clinical Ethics Review Board. Once completed, study findings will be presented at conferences and published in peer-reviewed journals. An online TB risk score calculator will also be created.

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Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis

Abstract: TST and IGRA data relating to immigrants are lacking, especially long-term follow-up and comparative data. Further data are urgently needed to determine TB risks after immigration, long-term TB development, and treatment outcomes.

Cited by 32 publications

References 62 publications

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Latent tuberculosis infection in HIV-infected adults of Kinshasa, DR Congo

Tuberculosis in a Portuguese Cohort

Predicting tuberculosis risk in the foreign-born population of British Columbia, Canada: study protocol for a retrospective population-based cohort study

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