Adults with Mycobacterium tuberculosis infection and pre-diabetes have increased levels of QuantiFERON interferon-gamma responses

Tuberculosis (Edinb). 2020 May:122:101935. doi: 10.1016/j.tube.2020.101935. Epub 2020 Apr 2.

Abstract

Background: Diabetes is associated with increased prevalence of TB infection in the US. We assessed associations between diabetes and interferon-gamma (IFN-γ) TB antigen response among adults with TB infection using US representative data.

Methods: National Health and Nutrition Examination (NHANES) participants >19 years from 2011 to 2012 with positive QuantiFERON®-TB Gold-In-Tube (QFT) results were eligible. Diabetes was defined by combination of self-report and glycated hemoglobin (HbA1c). Quantitative IFN-γ TB antigen was classified as high (≥10 IU/mL), intermediate (1.01-9.99 IU/mL), or low (0.35-1.00 IU/mL). Analyses accounted for NHANES weighted design.

Results: Among NHANES participants >19 years, n = 513 had positive QFT (5.9%). Among those with positive QFT, diabetes prevalence was 22.2% and pre-diabetes was 25.9%. Overall, 16.7% of positive QFT participants had high IFN-γ TB antigen levels including 21.7% among those with diabetes, 20.8% among those with pre-diabetes, and 12.6% among euglycemic participants. In adjusted analyses, high IFN-γ TB antigen response was more common among those with pre-diabetes (aOR 1.9, 95%CI 1.0, 3.6) compared to euglycemic participants.

Conclusion: Higher antigen responses may reflect immunopathy consistent with an exaggerated inflammatory but ineffectual response to TB or a reflection of more Mtb replication in participants with pre-diabetes or diabetes.

Keywords: Diabetes mellitus; Interferon-gamma; Tuberculosis infection.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Bacterial Load
  • Cross-Sectional Studies
  • Female
  • Host-Pathogen Interactions
  • Humans
  • Interferon-gamma / immunology*
  • Interferon-gamma Release Tests*
  • Latent Tuberculosis / diagnosis
  • Latent Tuberculosis / epidemiology
  • Latent Tuberculosis / immunology*
  • Latent Tuberculosis / microbiology
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / growth & development
  • Mycobacterium tuberculosis / immunology*
  • Nutrition Surveys
  • Prediabetic State / diagnosis
  • Prediabetic State / epidemiology
  • Prediabetic State / immunology*
  • Predictive Value of Tests
  • Prevalence
  • United States / epidemiology
  • Young Adult

Substances

  • IFNG protein, human
  • Interferon-gamma