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

Erlina Burhan, Ririen Razika Ramdhani, Jamal Zaini


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):)


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


World Health Organization. Global tuberculosis report 2015 : The burden of the disease caused by TB. Geneva:WHO Press;2015.p.6-27.

Centers for Disease Control and Prevention. Latent tuberculosis infection: a guide for primary health care providers. U.S. Department of Health and Human Services National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Georgia;2013.p.5-18.

Kementrian Kesehatan Republik Indonesia. Pedoman nasional pelayanan kedokteran : Tata laksana tuberkulosis. Kementrian Kesehatan RI. Jakarta;2013.p.1-80.

Sahrma V, Kerr SH, Kawar Z, Kerr DJ. Challenges of cancer control in developing countries: current status and future perspective. Future Oncol. 2011;7:1213-22.

World Health Organization. Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. [cited 2016 October 2016]. Availablefrom :

Wisnuwardhani D. Angka tahan hidup pada keganasan rongga toraks dengan sindrom vena kava superior pasca radioterapi segera di Rumah Sakit Persahabatan Jakarta. Tesis. Universitas Indonesia. Jakarta;2012.p.1-2.

Fan WC, Ting WY, Lee MC, Huang FS, Chiu CH, Lai SL, et al. Latent TB infection in newly diagnosed lung cancer patients : a multicenter prospective observational study. J Lung Cancer. 2014;07:1-7.

Wu CY, Hu HY, Pu CY, Huang N, Shen HC, Li CP, et al. Pulmonary tuberculosis increases the risk of lung cancer : a population based cohort study. Cancer. 2011;117:618-24.

Christopoulos A, Saif MW, Sarris EG, Syrigos KN. Epidemiology of active tuberculosis in lung cancer patients: a systematic review. Clin Respir J. 2014;12:1-7.

Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 1974; 33: 850-8.

Kamboj M, Sepkowitz KA. The risk of tuberculosis in patient with cancer. J Clin Infect Dis. 2006;42:1592-5.

Lin PL, Flynn JL. Understanding latent tuberculosis: a moving target. J Immunol. 2010;185:15–22.

Fujita T, Endo M, Gu Y, Sato T, Ohmagari N. Mycobacterium tuberculosis infection in cancer patients at a tertiary care cancer center in Japan. J Infect Chemother. 2014;20:213-6.

Sugino K, Homma S, Miyamoto A, Takaya H, Sakamoto S, Kawabata M, et al. Clinical analysis of lung cancer complicated by pulmonary tuberculosis. Jpn J Lung Cancer. 2007;47:97e103.

Bordiqnon V, Bultrini S, Prignano G, Sperduti I, Piperno G, Bonifati C, et al. High prevalence of latent tuberculosis in autoimmune disorders such as psoriasis and in chronic respiratory diseases, including lung cancer. J Biol Regul Homeost Agents. 2011;25(2):213-20.

Druszczynska M, Kulbat MK, Pol M, Wlodarczyk M, Rudnicka W. Latent M.tuberculosis infection pathogenesis, diagnosis, treatment and prevention strategies. Polish J of Microbiol. 2012;61(1):3-10.

World Health Organization.Guidelines on the management of latent tuberculosis infection. Geneva:WHO. Press;2015.p.2-31.

Zumla A, Raviglione M, Hafner R, von Reyn CF. Tuberculosis. N Engl J Med. 2013;368(8):745-55.

Dheda K, Schwander SK, Zhu B, van Zyl-Smit RN, Zhang Y. The immunology of tuberculosis: from bench to bedside. Respirology. 2010;15(3):433-50.

Russell DG. Mycobacterium tuberculosis: here today, and here tomorrow. Nat Rev Mol Cell Biol 2001;2(8):569-77.

Chee CB, Sester M, Zhang W, Lange C. Diagnosis and treatment of latent infection with Mycobacterium tuberculosis. Respirology.2012;18(2):205-16.

Mack U, Migliori GB, Sester M, Rieder HL, Ehlers S, Goletti D, et al. LTBI: latent tuberculosis infection or lasting immune responses to M.Tb? a TBNET consensus statement. Eur Respir J. 2009;33(5):956-73.

Narasimhan P, Wood J, Macintyre CR, Mathai

D. Risk Factors of Tuberculosis. Pulmonary Medicine. 2013;11:1-11.

Ahmad S. Pathogenesis, immunology, and diagnosis of latent mycobacterium tuberculosis infection. Clin Dev Immunol 2011;11:1-18.

Bass JB Jr, Farer LS, Hopewell PC. Treatment of tuberculosis and tuberculosis infection in adults and children: American Thoracic Society and Centers for Disease Control and Prevention. Am J Respir Crit Care Med. 1994;149:1359-74.

Riley LW. Immunology of tuberculosis. Journal [serial on the Internet]. 2014 [cited 2014 October 22]; Available from:URL: contents/immunology-of-tuberculosis.

Marais BJ, Lönnroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, et al. Tuberculosis comorbidity with communicable and non- communicable diseases: integrating health services and control efforts. Lancet.2013;3:1-13.

Pai M, Riley LW, Colford JM. Interferon- gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4(12):761-76.

Finn OJ. Cancer Immunology. N Engl J Med 2008;358:2704-15.

Hodge G, Barnawi J, Jurisevic C, Moffat D, Holmes M, Reynolds PN, et al. Lung cancer is associated with decreased expression of perforin, granzim B and interferon (IFN)-γ by infiltrating lung tissue T cells, natural killer (NK) T-like and NK cells. Clin and Exp Immun. 2014;178:79–85.

Martin F, Santolaria F, Batista N, Milena A, Gonza E, Oramas J. Cytokine levels, acute phase response and nutritional status as prognostic factors in lung cancer. Cytokine. 1999;11:80-6.

Pratomo IP. Penggunaan kompleks antigen ESAT-6 dan CFP-10 untuk diagnosis tuberkulosis. J Respir Indo. 2013;33(1):66-71.

Abdallah AM, Pittius NC, Champion PA, Cox J, Luirink J, Vandenbroucke-Grauls CM, et al. Type VII secretion--mycobacteria show the way. Nat Rev Microbiol. 2007;5(11):883-91.

Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet. 2000;356(9235):1099-104.

Sidi GR, Sepkowitz KA. IFN-γ release assays in the diagnosis of latent tuberculosis infection among immunocompromised adults. Am J Respir Crit Care Med. 2013;188: 422–31.

Oxford-Immunotec. T-SPOT.TB an aid in the diagnosis of tuberculosis infection-package insert. Journal [serial on the Internet]. 2013 [cited 2014 October 7]; Available from:URL: tional/ wp-content/uploads/sites/3/PI-TB-IVD- UK-v2f288.pdf.

Qiagen. QuantiFERON®-TB Gold (QFT®)- package inserts. Journal [serial on the Internet]. 2013 [cited 2014 September 23]; Available from:URL: tent/PI/QFT/2PK/US.pdf

Richeldi L, Losi M, D’Amico R, Luppi M, Ferrari A, Mussini C, et al. Performance of test for latent tuberculosis in different groups of immunocompromised patients. Chest 2009;136:198-204.

Rajagopalan S, Yoshikawa T. Tuberculosis in the elderly. J Gerontol Geriat 2000;33:374-80.

Perhimpunan Dokter Paru Indonesia. Pedoman tatalaksana infeksi TB laten. Jakarta:Badan Penerbit FKUI;2016.p.1-36.

Bhatt MLB, Kant S, Bhaskar R. Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian J of Cancer 2012;1:36-42.

Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Burhan E, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J. 2015;46:1563-76.

Mori T, Burhan E. Supporting progress towards the post-2015 targets and regional tuberculosis elimination: a statement of intent from the third meeting of the Asian TB Experts Community. Eur Respir J. 2015;45:1760-2

Sester M, Leth F, Bruchfeld J, Bumbacea D, Cirillo DM, Dilekasli AG, et al. Risk assesment of tuberculosis in immunocompromised patients. Am J Respir Crit Med. 2014;190:1168-76.

Zheng W, Blot WJ, Liao ML, Wang ZX, Levin LI, Zhao JJ, et al. Lung cancer and prior tuberculosis infection in Shanghai. Br J Cancer. 1987;56:501-4.

Engels EA, Shen M, Chapman RS, Pfeiffer RM, Yu YY, He X, el al. Tuberculosis and subsequent risk of lung cancer in Xuanwei, China. Int J Cancer. 2009;124:1183-7.

Liang HY, Li XL, Yu XS, Guan P, Yin ZH, He QC, et al. Facts and fiction of the relationship between preexizting tuberculosis and lung cancer risk : a systematic review. Int J Cancer. 2009;125:2936-44.



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