The Agreement Compatibility Level of Tuberculin Skin Test (TST) and POT.TB in Detecting Latent Tuberculosis Infection (LTBI) in Diabetic Mellitus (DM)

Pribadi M Sebayang, Reviono Reviono, Supriyanto Kartodarsono

Abstract


Background: The lifetime risk of TB reactivation develops within the first 5 years after initial infection. Good LTBI management helps in preventing the progression of the disease to be active. It is recommended in countries with a low prevalence of TB infection and high risk populations such as DM patients. The diagnosis of LTBI is done by examining TST and T-SPOT.TB. This study aimed to determine the correspondence between TST and T-SPOT.TB in detecting LTBI in DM patients.
Methods: This cross-sectional study was conducted in DM patients treated in Dr. Moewardi Hospital Surakarta in September 2018. The study subjects received TST by injecting intradermal PPD RT 23 2TU intradermally, and T-SPOT.TB by taking 6 ml of venous blood examined with ELISPOT method. Statistical analysis used SPSS21 for windows.
Results: There were 30 subjects. The prevalence of LTBI was 20%. The correspondence between TST and T-SPOT.TB was substantial (K=0.667, p<0.001). The sensitivity and specificity of TST and T-SPOT.TB were 14.3% and 100%, as well as 23.8% and 88.9% respectively. HbA1c level, history of TB contact and BCG scar were not significantly correlated with TST, meanwhile TB contact history was the only risk factor correlated with T-SPOT.TB.
Conclusion: TST examination has good compatibility with T-SPOT.TB. Therefore, it is recommended in low socio-economic countries. Early detection for LTBI is necessary in DM patients due to its possibility of reactivation. T-SPOT.TB has better specificity, but lower sensitivity than TST so it can be used to diagnose TB infection in DM patients.

Keywords


LTBI, TST, T-SPOT.TB, HbA1c, Diabetic

References


World Health Organization. Global Tuberculosis Report 2015. 20th Ed. [cited 2018 june 19th]. Available: http://www.who.int/iris/handle/10665/191102

Restrepo BI, Schlesinger LS. Impact of DM on the natural history of tuberculosis. DM Res Clin Pract. 2014;106:191–9.

Getahun H, Matteelli A, Abubakar I, et al. Management of latent mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries.EurRespir J. 2015;46:1563–76.

Lonnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global DM epidemic: from evidence to policy and practice. The lancet DM & endocrinology. 2014;2:730-9.

World Health Organization. Global tuberculosis report 2014. Geneva. [cited 2018 june 21th]. Available: www.who.int/tb/publication/global_report/ gtbr_executive_ summary.pdf.

IDF. DM Atlas, 6th Edition 2013. Epidemiology & Research. [cited 2018 june 21th]. Available: http//www.idf.org/e-library/epidemiology- research/DMatlas/ 19_atlas_6th_edition.html.

Food and agriculture organization of the united nations. Food security indicators. [cited 2018 june 20th]. Available: http://www.fao.org/economic

/ess/ess-fs/ess-fadata/it/#

Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS medicine 2008;5:15-2.

Odone A, Houben RM, White RG, Lonnroth K. The effect of DM and under nutrition trends on reaching 2035 global tuberculosis targets. The lancet DM & endocrinology. 2014;2:754-64.

Jeon CY, Murray MB. DM mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies. PLoS Med. 2008;5(7):1-52

Leung CC, Lam HT, Chan WM, et al. Diabetic control and risk of tuberculosis: A cohort study. Am J Epidemiology. 2008;167:1486-94.

Meng RL, Ya PH, Yu TK, Chen HL, Yun JS, Chin CS, Jun YW et al. Diabetes Mellitus and Latent Tuberkulosis Infection: A Systemic Review and Meta analysis. Cli Infect Dis. 2017:64(6):719-27.

Diel R, Loddenkemper R, Nienhaus A. Evidence-based comparison of commercial Interferon - γ Release Assays for detecting active TB. Chest. 2010;137:952-68.

Zhu C, Liu Z, Li Z, Mei S, Hu Z. The performance and limitation ot T-Spot TB for the diagnose of TB in a high prevalence setting. J Thorac Dis. 2014;6(6):713-719.

Hizel K, Maral I, Karakus R, Aktas F. The influence of BCG immunisation on tuberculin reactivity and booster effect in adults in a country with a high prevalence of tuberculosis. Clin Microbiol Infect. 2004;10:980-3.

Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR. Diabetes Mellitus and Tuberculosis facts and controversies. Journal of Diabeties & Metabolic Disorders. 2013;12:58.

Lee PH, Fu H, Lai TC, Chiang CY, Chan CC, Lin HH. Glycemic control and the risk of tuberculosis: A Cohort study. Plos medicine. 2016;13(8):e1002072.

Perhimpunan Dokter Paru Indonesia. Pedoman tatalaksana infeksi TB laten. Jakarta: Perhimpunan Dokter Paru Indonesia; 2016. p. 1-38.




DOI: https://doi.org/10.36497/jri.v39i4.78

Refbacks

  • There are currently no refbacks.





Jurnal Respirologi Indonesia
pISSN: 0853-7704 - eISSN: 2620-3162
Address: Jalan Cipinang Bunder No. 19, Cipinang, Pulogadung, Jakarta Timur, DKI Jakarta 13240, Indonesia
Phone: +62-21-2247-4845
Email: editor@jurnalrespirologi.org


An official publication by
the Indonesian Society of Respirology (ISR)

Creative Commons License
Creative Commons Attribution-NonCommercial 4.0 International License

Statcounter