Severe undernutrition in children affects tuberculin skin test performance in Southern India

Undernutrition impairs immunity to Mycobacterium tuberculosis and is a risk factor for tuberculosis disease (TB). We aim to investigate if severe undernutrition affects the tuberculin skin test (TST) response among household contacts (HHCs) of pulmonary TB cases. We analyzed data from HHCs (> fiv...

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Bibliographic Details
Published in:	PloS one 2021-07, Vol.16 (7), p.e0250304-e0250304
Main Authors:	Reddy, Divya, Ma, Yicheng, Lakshminarayanan, Subitha, Sahu, Swaroop, White, Laura F, Reshma, Ayiraveetil, Roy, Gautam, Salgame, Padmini, Knudsen, Selby, Cintron, Chelsie, Ellner, Jerrold J, Horsburgh, Jr, C Robert, Sarkar, Sonali, Hochberg, Natasha S
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Adults Age Alcohol use BCG BCG vaccines Biology and Life Sciences Biomarkers Body mass Body mass index Body size Child Child, Preschool Children Disease prevention Disease susceptibility Enrollments Epidemiology Evaluation Health aspects Health risks HIV Human immunodeficiency virus Humans India Infant Infections Infectious diseases Malnutrition Malnutrition in children Medical education Medical tests Medicine Medicine and Health Sciences People and Places Physical Sciences Prevalence Public health Questionnaires Risk analysis Risk Factors Skin Skin tests Tuberculin Tuberculin Test Tuberculosis Tumor necrosis factor-TNF Undernutrition
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Summary:	Undernutrition impairs immunity to Mycobacterium tuberculosis and is a risk factor for tuberculosis disease (TB). We aim to investigate if severe undernutrition affects the tuberculin skin test (TST) response among household contacts (HHCs) of pulmonary TB cases. We analyzed data from HHCs (> five years) of pulmonary TB cases in Southern India. Undernutrition was defined as per World Health Organization based on body mass index (BMI) for adults (undernutrition 16-18.4 and severe undernutrition five mm) were calculated using logistic regression with generalized estimating equations. Among 1189 HHCs, 342 were children (age 5-17 years) and 847 were adults. Prevalence of TST positivity in well-nourished, undernourished and severely undernourished children was 135/251 (53.8%), 32/68 (47.1%), and 7/23 (30.4%) respectively; among adults, prevalence of TST positivity was 304/708 (42.9%), 43/112 (38.4%) and 12/26 (46.2%), respectively. Severe undernutrition in children was associated with decreased odds of TST positivity (adjusted odds ratio 0.3; 95%CI 0.1-0.9). Severe undernutrition in children was associated with decreased odds of TST positivity. False-negative TSTs may result from undernutrition; caution is warranted when interpreting negative results in undernourished populations.
ISSN:	1932-6203 1932-6203