The Effect of Diabetes and Prediabetes on Mycobacterium tuberculosis Transmission to Close Contacts

Background:

Diabetes mellitus (DM) is a well-known risk factor for developing active tuberculosis (TB) and experiencing poor clinical outcomes. However, it is currently unknown whether dysglycemia (prediabetes or DM) in persons with tuberculosis (PWTB) is associated with increased Mycobacterium tuberculosis transmission to their close contacts. Understanding this relationship is vital for improving TB control strategies, especially in countries with a high burden of both diseases.

Abstract:

Methods: This multicenter prospective cohort study in Brazil assessed 592 PWTB (153 with DM, 141 with prediabetes, and 211 normoglycemic) and their 1,784 close contacts. Contacts were investigated at baseline and 6 months using QuantiFERON-TB Gold In-Tube (QFT). Multivariable mixed-effects logistic regression models tested independent associations with baseline QFT positivity and QFT conversion.

Results: Among the contacts, 658 were QFT-positive at baseline and 106 converted by month 6. In PWTB, prediabetes was independently associated with baseline QFT positivity in contacts, while DM, persistent cough, acid-fast bacilli (AFB) positivity, and pulmonary cavities were associated with QFT conversion. Contacts living with a smoker also had higher odds of baseline positivity.

Conclusion: Contacts of PWTB with dysglycemia are at a significantly increased risk of being QFT-positive or undergoing QFT conversion. These findings suggest that dysglycemia increases Mtb transmission, highlighting the need for targeted TB control efforts among these close contacts.

Keywords: diabetes, prediabetes, quantiFERON, interferon-$\gamma$ releasing assay, Mycobacterium tuberculosis.

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• Data de Publicação: 19/05/2021
• Autores: María B Arriaga, Michael S Rocha, Betânia M F Nogueira, Vanessa Nascimento, Mariana Araújo-Pereira, Alexandra B Souza, Alice M S Andrade, Alysson G Costa, Adriano Gomes-Silva, Elisangela C Silva