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. 2019 Mar 26;14(3):e0214556.
doi: 10.1371/journal.pone.0214556. eCollection 2019.

Prevalence of latent tuberculosis in homeless persons: A single-centre cross-sectional study, Germany

Friederike von Streit  1 , Christoph Bartels  2 , Thorsten Kuczius  3 , Christoph Cassier  4 , Joachim Gardemann  5 , Frieder Schaumburg  1
Affiliations

Prevalence of latent tuberculosis in homeless persons: A single-centre cross-sectional study, Germany

Friederike von Streit et al. PLoS One. .

Abstract

Purpose: Homeless persons have a high risk for tuberculosis. The prevalence of latent tuberculosis infection and the risk for a progression to active tuberculosis is higher in the homeless than in the general population. The objective was to assess the prevalence and risk factors of tuberculosis/latent tuberculosis infection in a homeless population in Germany.

Methods: Homeless individuals (n = 150) were enrolled in a cross-sectional study at three shelters in Münster, Germany (October 2017-July 2018). All participants were screened using an ELISPOT interferon-γ release assay (IGRA). Those participants tested positive/borderline by IGRA provided three sputa for microbiological analysis (line probe assay, microscopy, culture) and underwent a chest X-ray to screen for active pulmonary TB. Risk factors for tuberculosis/latent tuberculosis infection were analysed using a standardized questionnaire.

Results: Of the 142 evaluable IGRA, 21 (15%) were positive and two (1%) were borderline. No participant with a positive/borderline IGRA had an active tuberculosis as assessed by chest X-ray and microbiology. A negative IGRA was associated with a citizenship of a low-incidence country for tuberculosis (according to WHO, p = 0.01), low-incidence country of birth (p<0.001) or main residence in a low-incidence country in the past five years (p = 0.002).

Conclusions: The prevalence of latent tuberculosis infection (diagnosed by a positive/borderline IGRA) was 16%; no active tuberculosis was detected. The highest risk for latent tuberculosis infection was found in patients from high-incidence countries. This population at risk should be either treated for latent tuberculosis infection or need to be monitored to early detect a progression into active disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diagnostic procedures to determine tuberculosis (TB) infections in participants.
All Participants were tested by Interferon-gamma release assay (IGRA). Patients with borderline/positive IGRA results were screened for active pulmonary TB. Latent TB infection (LTBI) was defined as “a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifest active TB” according to the World Health Organization [4].
See this image and copyright information in PMC

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