Programmpunkt

17:40

Titel: Prevalence of tuberculosis in homeless persons in Münster, Deutschland
ID: 28/KMV
Art: Abstractautor
Session: Workshop 05
Diagnostic Stewardship - "Meet the needs of your partners!" (FG DKM, FG QD)

Referent: Friederike von Streit (Münster)


Abstract - Text

Introduction

The incidence of tuberculosis (TB) in Germany is increasing again since 2013. Homeless persons are a risk group for infectious diseases in general and TB in particular. Among individuals with latent TB infection (LTBI), homeless persons run a higher risk to develop active TB compared to the general population. Specifically, the prevalence of TB and LTBI in homeless persons in Germany is largely unknown.

Aim

We aimed to assess the prevalence of TB/LTBI in homeless persons and to identify risk factors for TB/LTBI.

Material & Methods

A total of 150 homeless persons were recruited in Münster, Germany, between October 2017 and July 2018. Participants were screened for exposure to Mycobacterium tuberculosis complex using T-SPOT®TB (Oxford Immunotec, UK), an Interferon-gamma release assay (IGRA). IGRA-positive participants were additionally screened for active pulmonary TB by analysing three sputa using a line-probe assay (GenoType® MTBDRplus, Hain, Germany), microscopy, culture (solid and liquid media) and chest X-ray (Figure 1). Risk factors for LTBI/TB were assessed using a standardized questionnaire.

Results

Of 142 evaluable IGRA results, 21 (15%) were positive and 2 (1%) were borderline. The IGRA-negative group included more likely German citizens (63% vs. 35%, p=0.01), persons born in Germany (57% vs. 22%, p<0.001) or persons residing mainly in Germany during the past five years (82% vs. 67%, p=0.005) compared to the IGRA-positive group.

Participants also had more likely a negative IGRA if they were citizens of a low-TB-incidence country according to WHO (52% vs. 26%, p=0.01), were born in a low-incidence country (70% vs. 30%, p<0.0005).Cough for more than three weeks was also associated with a positive IGRA result (24% vs. 44%, p=0.05). All IGRA-positive participants were screened for active TB by microbiological analysis of sputa and chest X-ray; no case was found.

Summary

The prevalence of LTBI (diagnosed by a positive/borderline IGRA) was 16% in our population of homeless persons; no active TB was detected. Treatment of LTBI can be considered in homeless persons with positive IGRA. The highest risk for LTBI was found in persons from high-incidence countries.

Figure Legend

Figure 1: Diagnostic procedures to determine tuberculosis (TB) infections in homeless persons. All Participants were tested by Interferon-gamma release assay (IGRA). Patients with borderline/positive IGRA results were screened for active pulmonary TB.