title: Prevalence of tuberculosis symptoms and latent tuberculous infection among prisoners in northeastern Malaysia.
abstract: METHODS
  There are currently no routine screening procedures for active tuberculosis (TB) or latent tuberculous infection (LTBI) in Malaysian prisons.
  
  
  OBJECTIVE
  To determine the prevalence and correlates of LTBI and active TB symptoms among Malaysian prisoners with and without human immunodeficiency virus (HIV) infection using the tuberculin skin test (TST) and the World Health Organization TB symptom-based screening instrument.
  
  
  METHODS
  A cross-sectional survey of 266 prisoners was performed in Kelantan, Malaysia. Consenting participants underwent two-step TST and were screened for active TB symptoms. Standardized cut-offs of respectively ≥5 and ≥10 mm were used to define reactive TST among prisoners with and without HIV. Clinical and behavioral data were assessed and HIV-infected prisoners were stratified by CD4 status.
  
  
  RESULTS
  Overall LTBI prevalence was 87.6%, with significantly lower TST reactivity among HIV-infected than non-HIV-infected prisoners (83.6% vs. 91.5%, P < 0.05); however, TB symptoms were similar (16.9% vs. 10.1%, P = 0.105). On multivariate analysis, previous incarceration (aOR 4.61, 95%CI 1.76-12.1) was the only significant correlate of LTBI. Increasing age (aOR 1.07, 95%CI 1.01-1.13), lower body mass index (aOR 0.82, 95%CI 0.70-0.96) and TST-reactive status (aOR 3.46, 95%CI 1.20-9.97) were correlated with TB symptoms.
  
  
  CONCLUSIONS
  LTBI is highly prevalent, associated with previous incarceration, and suggests the need for routine TB screening on entry to Malaysian prisons.
authors.affiliation: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: B
authors.initials: B
authors.lastname: Margolis
authors.forename: H A A
authors.initials: HA
authors.lastname: Al-Darraji
authors.forename: J A
authors.initials: JA
authors.lastname: Wickersham
authors.forename: A
authors.initials: A
authors.lastname: Kamarulzaman
authors.forename: F L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D012307:Risk Factors; D014374:Tuberculin Test