title: Risk for latent and active tuberculosis in Germany.
abstract: OBJECTIVE
  Few individuals that are latently infected with M. tuberculosis latent tuberculosis infection(LTBI) progress to active disease. We investigated risk factors for LTBI and active pulmonary tuberculosis (PTB) in Germany.
  
  
  METHODS
  Healthy household contacts (HHCs), health care workers (HCWs) exposed to M. tuberculosis and PTB patients were recruited at 18 German centres. Interferon-γ release assay (IGRA) testing was performed. LTBI risk factors were evaluated by comparing IGRA-positive with IGRA-negative contacts. Risk factors for tuberculosis were evaluated by comparing PTB patients with HHCs.
  
  
  RESULTS
  From 2008-2014, 603 HHCs, 295 HCWs and 856 PTBs were recruited. LTBI was found in 34.5% of HHCs and in 38.9% of HCWs. In HCWs, care for coughing patients (p = 0.02) and longstanding nursing occupation (p = 0.04) were associated with LTBI. In HHCs, predictors for LTBI were a diseased partner (odds ratio 4.39), sexual contact to a diseased partner and substance dependency (all p < 0.001). PTB was associated with male sex, low body weight (p < 0.0001), alcoholism (15.0 vs 5.9%; p < 0.0001), glucocorticoid therapy (7.2 vs 2.0%; p = 0.004) and diabetes (7.8 vs. 4.0%; p = 0.04). No contact developed active tuberculosis within 2 years follow-up.
  
  
  CONCLUSIONS
  Positive IGRA responses are frequent among exposed HHCs and HCWs in Germany and are poor predictors for the development of active tuberculosis.
authors.affiliation: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.|Center for Clinical Studies, Research Center Borstel, Borstel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herzmann
authors.affiliation: Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.affiliation: DAHW German Leprosy and Tuberculosis Relief Association, Würzburg, Germany.
authors.forename: Oswald
authors.initials: O
authors.lastname: Bellinger
authors.affiliation: Institute of Epidemiology, University Medical Hospital Schleswig-Holstein, Campus Kiel, Germany.|LungenClinic Grosshansdorf, Airway Research Center North, Großhansdorf, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Diel
authors.affiliation: Municipal Health Authority Hannover, Hanover, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Gerdes
authors.affiliation: Municipal Health Authority Frankfurt, Frankfurt, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Goetsch
authors.affiliation: Municipal Health Authority Hannover, Hanover, Germany.
authors.forename: Helga
authors.initials: H
authors.lastname: Heykes-Uden
authors.affiliation: Center of Pneumology, Agaplesion Deaconess Hospital Rotenburg, Rotenburg, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Schaberg
authors.affiliation: Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany. clange@fz-borstel.de.|German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany. clange@fz-borstel.de.|International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany. clange@fz-borstel.de.|Department of Medicine, Karolinska Institute, Stockholm, Sweden. clange@fz-borstel.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Diabetes mellitus; Health care workers; Household contacts; IGRA; Incidence; LTBI