High prevalence of Mycobacterium tuberculosis infection and disease in children and adolescents with type 1 diabetes mellitus.
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.
Webb
E A
EA
Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Stellenbosch University and Tygerberg Children's Hospital, Cape Town, South Africa. emmaalicewebb@yahoo.com
Hesseling
A C
AC
Schaaf
H S
HS
Gie
R P
RP
Lombard
C J
CJ
Spitaels
A
A
Delport
S
S
Marais
B J
BJ
Donald
K
K
Hindmarsh
P
P
Beyers
N
N
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