Erythema nodosum and the risk of tuberculosis in a high incidence setting

OBJECTIVE: This study estimates the erythema nodosum (EN) incidence in a tuberculosis (TB) endemic setting and evaluates the likelihood of a subsequent TB diagnosis among individuals with Mycobacterium tuberculosis infection (MTI) with or without EN. DESIGN: We estimated EN incidence rates (IRs) in...

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Bibliographic Details
Published in:International Journal of Circumpolar Health
Main Authors: Bjorn-Mortensen, Karen, Ladefoged, Karin, Simonsen, Jacob, Michelsen, Sascha W, Sørensen, Hans Christian F, Koch, Anders, Lillebaek, Troels, Andersen, Aase Bengaard, Soborg, Bolette
Format: Article in Journal/Newspaper
Language:English
Published: 2016
Subjects:
Greenland
Circumpolar Health
East Greenland
International Journal of Circumpolar Health
Online Access:https://portal.findresearcher.sdu.dk/da/publications/556d13e5-4a90-4485-8600-f140e1230c11
https://doi.org/10.3402/ijch.v75.32666
https://findresearcher.sdu.dk/ws/files/123003152/Erythema_nodosum_and_the_risk_of_tuberculosis_in_a_high_incidence_setting.pdf
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Summary:OBJECTIVE: This study estimates the erythema nodosum (EN) incidence in a tuberculosis (TB) endemic setting and evaluates the likelihood of a subsequent TB diagnosis among individuals with Mycobacterium tuberculosis infection (MTI) with or without EN. DESIGN: We estimated EN incidence rates (IRs) in East Greenland in 2010-2011 and conducted a cohort study following all individuals who tested positive for MTI from 1 January 2010 until 31 December 2012. A personal identifier allowed individual follow-up in the mandatory TB register. MTI was defined by a positive interferon-gamma release assay. TB incidence rate ratios (IRRs) among participants with or without EN were estimated with the Cox proportional hazard model. RESULTS: We identified 38 EN cases corresponding to an IR of 500/100,000 inhabitants/year. All cases were among individuals with MTI. The EN IR was 11.79 (95% CI 5.73-24.27) times higher for BCG-unvaccinated compared with BCG-vaccinated individuals. The TB IRR was 25 (95% CI 11-60) within 1 month of EN compared to individuals without EN. CONCLUSION: This study documents a high EN incidence in a TB endemic region. EN occurred only in individuals with MTI, and predominantly among BCG-unvaccinated individuals. EN was significantly associated with a TB diagnosis within 1 month of diagnosis.

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