The Proportion of Latent Tuberculosis Infection in Naive Lung Cancer Patients at Persahabatan Hospital Jakarta

Erlina Burhan, Ririen Razika Ramdhani, Jamal Zaini

Abstract


Background : Lung cancer and pulmonary tuberculosis (TB) are two major public health problems associated with significant morbidities and mortalities. The increased prevalence of active TB and latent TB reactivation in lung cancer patients and the negative effect of pulmonary TB in lung cancer prognosis underline the need for a through screening of lung cancer patients for latent TB infection (LTBI). The aims of this study are to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them.
Methods : This study used a cross-sectional design and sample was collected using consecutive sampling of the 86 newly diagnosed treatment-naive lung cancer patients from a referral respiratory hospital, Rumah Sakit Umum Pusat Persahabatan Jakarta in 2015 to 2016. The presence of LTBI was determined by Quantiferon-TB Gold-In-Tube (QFT- GIT) after having Mycobacterium TB not detected result from Xpert MTB/RIF sputum test. Demographic characteristics and cancer-related factors associated with LTBI were investigated.
Results : There are 11 patients (12,8%) with IGRA (+) result and 16 patients (18,6%) with IGRA indeterminate (I) result. Sociodemographic characteristics of lung cancer patients with latent TB are 63,6% male, mean of age 56 years, 36,4% with BCG immunization, 9% had TB close contacts history, 72,7% with a history of smoking. The clinical characteristics of these patients are 90% had a normal nutritional status with the median body mass index (BMI) 19,12 (18,24-29,26) kg/m2, the median of total lymphocyte count is 1856 (1197-4210) cells/ul, 9% with diabetes mellitus as comorbid, 81,8% of lung tumour located in the typical predilection for pulmonary tuberculosis. Most types of lung cancer are adenocarcinomas (81.8%) with advanced stage (81,8%) and the WHO performance status of 2-3 (63,6%). Characteristics having significant relationship with IGRA (+) results is the tumour located in the typical TB area radiologically. Low total lymphocyte count is associated with indeterminate IGRA results with median 999,88 (277- 1492,6) cells/ul.
Conclusion : The proportion of latent TB in lung cancer patients is 12,8%. Characteristics of patients with lung cancer associated with latent TB is the location of the tumor lesions typical of the area although it can not be concluded biologically. Having indeterminate IGRA results in lung cancer patients with a low total lymphocyte count showed the limitations of QFT-GIT in detecting latent TB infection in immunocompromised patients. (J Respir Indo. 2019; 39(4):)

Keywords


latent TB infection, lung cancer, IGRA, total lymphocyte count

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DOI: https://doi.org/10.36497/jri.v39i4.73

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