The prevalence of diabetes among tuberculosis patients in Denmark.

SETTING: It is estimated that 25% of the world's population are infected with Mycobacterium tuberculosis and that 463 million people are living with diabetes mellitus (DM), a number that is increasing. Patients with DM have three times the risk of developing tuberculosis (TB) and there is significant interaction between DM and TB, suggesting that DM affects not only risk of TB but also TB presentation, treatment response and outcome. OBJECTIVE: The aim was determining the prevalence of DM among TB patients in Denmark and to assess risk factors. DESIGN: Patient files from all notified TB cases in Denmark from 2009 to 2014 were retrospectively assessed. RESULTS: In total, 1912 patients were included and 5.0% had DM. Patients with DM were older, had more comorbidities, came from outside Denmark, and had a higher mortality compared to non-DM-patients. None of the patients from Greenland had DM. Patients with low socio-economic status had a low prevalence of DM. We found a higher prevalence of DM among Danish-born < 54 year and migrant ≥ 75 year compared to a Danish background population. CONCLUSION: We found a higher prevalence of DM among TB patients with known risk factors, and a surprisingly low prevalence among patients with low socioeconomic status and patients from Greenland.

Recurrent Plasmodium vivax malaria due to dose-dependent primaquine resistance: a case report.

The ability of Plasmodium vivax to relapse is a challenge to its management. Primaquine is the only drug licensed for the eradication of hypnozoites. We report the case of a non-immune traveller, who required high dosage primaquine treatment to obtain radical cure of vivax malaria, emphasizing the importance of country-specific and weight-based dosing of primaquine.

[Isoniazid-inducedtoxic hepatitis].

Hepatotoxicity is a well-known side effect to isoniazid treatment with the risk of progression to liver failure. This case report describes a 39-year-old male, who received standard isoniazid treatment for latent TB infection (LTBI) and developed severe isoniazid-induced acute hepatitis. Liver transplantation was considered, but the patient slowly recovered with full hepatic regeneration. With increasing focus on treating LTBI in Denmark, routine follow-up including biochemical monitoring should be implemented for patients receiving LTBI treatment to prevent severe complications.

Long-term risk of tuberculosis among migrants according to migrant status: a cohort study.

BACKGROUND: The majority of tuberculosis (TB) cases in low-incidence countries occur in migrants. Only few studies have assessed the long-term TB risk in migrants after immigration, and datasets have not considered this across a range of diverse migrant groups. This nationwide study aimed to investigate long-term TB risk among migrants according to migrant status and region of origin. METHODS: This cohort study included all migrants aged ≥ 18 years who obtained residence in Denmark from 1993 to 2015, with a mean follow-up of 10.8 years [standard deviation (SD) 7.3]. Migrants were categorized based on legal status of residence and region of origin. Incidence rates (IR) and rate ratios (IRR) were estimated by Poisson regression. RESULTS: A total of 142 314 migrants were included. Across all migrants, the TB risk was highest during year 1 of residence (IR 275/100 000 person-years; 95% CI 249-305) followed by a gradual decline, though TB risk remained high for over a decade. Compared with the Danish-born population, the IRRs after 7-8 years were particularly higher among former asylum seekers (IRR 31; 95% CI 20-46), quota refugees (IRR 31; 95% CI 16-71), and family-reunified with refugees (IRR 22; 95% CI 12-44). Sub-Saharan African migrants also experienced elevated risk (IRR 75; 95% CI 51-109). The proportion of migrants with pulmonary TB was 52.4%. CONCLUSION: All migrant groups experienced an initial high TB risk, but long-term risk remained high in key migrant groups. Most European countries focus TB screening on or soon after arrival. Our study suggests that approaches to TB screening should be adapted, with migrant populations benefiting from long-term access to preventive health services.

[Testing for latent tuberculosis infection needs to be improved in Denmark].

Tuberculosis (TB) remains a public health emergency worldwide. WHO recommends low-incidence countries to increase awareness of latent tuberculosis infection (LTBI) as part of a national preventive strategy. This review focuses on the burden of TB in Denmark, which might be reduced, if more focus was paid on diagnosing LTBI in relevant patients, and treatment to prevent future active TB cases was initiated. LTBI testing should be considered in persons at risk of TB disease, who will benefit from LTBI treatment, e.g. recently infected persons or persons having undergone organ transplantation or having comorbidity such as HIV, dialyses, and immunosuppression.

[Tuberculosis among asylum seekers].

Global migration is increasing, including migration from tuberculosis (TB) high-incidence countries to TB low-incidence countries as Denmark. Asylum seekers are at increased risk of having TB, and screening for TB is potentially highly relevant in Europe. However, there is a large variation in the ways screening is carried out and in the yield of the different screening programmes. There is a need of more quality data on how effectively to target the screening among asylum seekers, considering both the TB incidence in the country of origin and the risk factors along the migration route.

Delayed diagnosis of severe tuberculous spondylodiscitis in an asylum seeker; patient or doctors delay?

The still increasing global migration affects the epidemiology of tuberculosis (TB) in European countries. We present the case of an asylum seeker from a TB high-endemic country, who presented with severe TB spondylodiscitis and need for emergency surgery. The patient had a history of recurrent sterile axillary and perianal abscesses for years, but TB was never properly ruled out. The patient underwent surgery, responded well to antibiotics and regained the ability to walk. After 6 month of treatment the patient was lost to follow-up. In light of the increasing migration from TB high-endemic countries to low-endemic countries, this case illustrates the paramount importance of minding TB as a differential diagnosis.