871. Latent And Pulmonary Tuberculosis Screening Practices at Diabetes Clinics in Southern India
Session: Poster Abstract Session: Infection Control in Resource-Limited Settings
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA poster_Alex Ambinder.pdf (534.8 kB)
  • Background: Diabetes mellitus increases the risk of tuberculosis (TB) by 2-3 fold. The global rise in diabetes prevalence may serve to fuel higher rates of TB in endemic areas, highlighting the need for TB screening within these populations. We aimed to characterize latent TB and pulmonary TB screening practices and to estimate the incidence of pulmonary TB in two diabetes clinics in Chennai, India.

    Methods: Consecutive patients at two diabetes clinics, one rural and one urban, were included in this study. Data from their first and most recent clinical evaluations were analyzed. All patients underwent baseline chest radiography (CXR) at presentation to the clinics and yearly CXRs thereafter. Changes from baseline consistent with pulmonary TB were noted and the incidence was calculated. Tuberculin skin testing data were also extracted for all patients who underwent such screening. An informal review of current diabetes guidelines regarding TB screening was conducted. All analyses were done using R.

    Results: 443 subjects were included in this study and had a mean follow up time of 6.82 years. At baseline, one of the 443 patients had pulmonary TB. Comparisons of recent CXRs to baseline found that one patient developed pulmonary TB during the course of care (calculated incidence = 1 person/3021 person-years). Only three (0.7%) patients were screened for tuberculosis using the tuberculin skin test, and of them, one had induration consistent with latent TB and a normal CXR. In an informal review of recently published diabetes management guidelines, only 2 of 11 recommended either LTBI or pulmonary TB screening, whereas 5 of 11 recommended pneumococcal/influenza vaccination.

    Conclusion: The incidence of CXR-assessed pulmonary TB in this patient population was relatively low. LTBI screening was not routinely practiced, and its role in a high prevalence population of diabetes patients is unclear. Clarifying the role and preferred modalities for TB screening in diabetes guidelines may help to mitigate diabetes-related TB transmission, morbidity, and mortality.

    Alexander Ambinder1, Emily Mcintosh1, Lulu Tian1, Nikkil Sudharsanan1, Mohammed Ali, MBChB, MSc, MBA1, Pradeepa Rajendra, PhD2, Mohan Viswanathan, M.D., PhD, D.Sc.2 and Carlos Del Rio, MD, FIDSA1, (1)Global Health, Emory Univ. Rollins Sch. of Publ. Health, Atlanta, GA, (2)Madras Diabetes Research Foundation, Chennai, India

    Disclosures:

    A. Ambinder, None

    E. Mcintosh, None

    L. Tian, None

    N. Sudharsanan, None

    M. Ali, None

    P. Rajendra, None

    M. Viswanathan, None

    C. Del Rio, None

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