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. 2015 Apr 23;10(4):e0124260.
doi: 10.1371/journal.pone.0124260. eCollection 2015.

Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India

Baskaran Dhanaraj  1 , Mohan Kumar Papanna  2 , Srividya Adinarayanan  1 , Chandrasekaran Vedachalam  1 , Vijayaraj Sundaram  1 , Shivakumar Shanmugam  1 , Gomathi Sekar  1 , Pradeep Aravindan Menon  1 , Fraser Wares  3 , Soumya Swaminathan  1
Affiliations

Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India

Baskaran Dhanaraj et al. PLoS One. .

Abstract

Background: The present study measured the community prevalence and risk factors of adult pulmonary tuberculosis (PTB) in Chennai city, and also studied geographical distribution and the presence of different M. tuberculosis strains in the survey area.

Methods: A community-based cross sectional survey was carried out from July 2010 to October 2012 in Chennai city. Prevalence of bacteriologically positive PTB was estimated by direct standardization method. Univariate and multivariate analyses were carried out to identify significant risk factors. Drug susceptibility testing and spoligotyping was performed on isolated M. tuberculosis strains. Mapping of PTB cases was done using geographic positioning systems.

Results: Of 59,957 eligible people, 55,617 were screened by X-ray and /or TB symptoms and the prevalence of smear, culture, and bacteriologically positive PTB was estimated to be 228 (95% CI 189-265), 259 (95% CI 217-299) and 349 (95% CI 330-428) per 100,000 population, respectively. Prevalence of smear, culture, and bacteriologically positive PTB was highest amongst men aged 55-64 years. Multivariate analysis showed that occurrence of both culture and bacteriologically positive PTB disease was significantly associated with: age >35 years, past history of TB treatment, BMI <18.5 Kgs/m2, solid cooking fuel, and being a male currently consuming alcohol. The most frequent spoligotype family was East African Indian. Spatial distribution showed that a high proportion of patients were clustered in the densely populated north eastern part of the city.

Conclusion: Our findings demonstrate that TB is a major public health problem in this urban area of south India, and support the use of intensified case finding in high risk groups. Undernutrition, slum dwelling, indoor air pollution and alcohol intake are modifiable risk factors for TB disease.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Age and sex wise prevalence of smear positive pulmonary TB.
Fig 2
Fig 2. Age and sex wise prevalence of culture positive pulmonary TB.
Fig 3
Fig 3. Age and sex wise prevalence of bacteriologically positive pulmonary TB.
Fig 4
Fig 4. Dendrogramme showing Spoligotyping results among bacteriologically positive pulmonary TB cases in Chennai.
Tree presenting the spoligotyping patterns Mycobacterium tuberculosis isolates n = profiles by using Bionumerics software with jaccards coefficient. EAI: East African Indian has six subtypes EAI1-6. IND: India, SOM: Somalia, BGD: Bangladesh is represented here. Orphan strains are defined as strains which are not present in the SpolDB4 spoligotype international database of the institute Pasteur de la Guadeloupe.
Fig 5
Fig 5. Spatial Distribution of bacteriologically positive TB cases in Chennai.
See this image and copyright information in PMC

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