title: High prevalence of Mycobacterium tuberculosis infection and disease in children and adolescents with type 1 diabetes mellitus.
abstract: METHODS
  Western Cape Province, South Africa.
  
  
  OBJECTIVE
  To describe the prevalence of tuberculosis (TB) infection and disease in children with type 1 diabetes and to investigate the association between glycaemic control and prevalence of TB infection and disease.
  
  
  METHODS
  Cross-sectional hospital-based study conducted at two public referral hospitals. All children and adolescents (aged <21 years) with type 1 diabetes underwent a Mantoux tuberculin skin test (>or=10 mm classified as Mycobacterium tuberculosis infection), measurement of glycosylated haemoglobin and a chest radiograph. Patients with symptoms suggestive of TB were investigated using mycobacterial culture. Radiologically and/or bacteriologically confirmed disease was classified as TB disease.
  
  
  RESULTS
  Of 291 eligible patients, 258 (88.7%) were included (58% female). The prevalence of M. tuberculosis infection was 29.8% (95%CI 24.2-35.4); nine patients were diagnosed with prevalent TB disease (point prevalence disease 3488 per 100,000 population). Poor glycaemic control (hazard ratio 1.39, 95%CI 1.18-1.63 per unit increase in glycated haemoglobin [HbA1c]) and contact with a TB source case (P = 0.0011) was associated with prevalent TB disease.
  
  
  CONCLUSIONS
  There is a high prevalence of TB disease in diabetic children and adolescents in this setting. Routine TB screening of children with type 1 diabetes may be indicated in settings highly endemic for TB. Preventive treatment should be considered for diabetic children with proof of TB exposure and/or infection.
authors: Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa. emmaalicewebb@yahoo.com
authors: E A
authors: EA
authors: Webb
authors: A C
authors: AC
authors: Hesseling
authors: H S
authors: HS
authors: Schaaf
authors: R P
authors: RP
authors: Gie
authors: C J
authors: CJ
authors: Lombard
authors: A
authors: A
authors: Spitaels
authors: S
authors: S
authors: Delport
authors: B J
authors: BJ
authors: Marais
authors: K
authors: K
authors: Donald
authors: P
authors: P
authors: Hindmarsh
authors: N
authors: N
authors: Beyers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult