Coeliac disease and risk of tuberculosis – A population-based cohort study

Jonas F Ludvigsson ^1*, Jan Wahlstrom ², Johan Grunewald ², Anders Ekbom ³ and Scott Montgomery ⁴

¹ Dept. Paediatrics, Sweden
² Division of Respiratory Medicine, Department of Medicine, Karolinska University Hospital/Institute, Sweden
³ Clinical Epidemiology Unit, Dept of Medicine, Karolinska Univ; and Harvard Medical School, Boston, Sweden
⁴ Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital/Institute, Sweden

^* To whom correspondence should be addressed. E-mail: jonasludvigsson{at}yahoo.com.

Accepted 30 May 2006

Abstract

Background: Coeliac disease (CD) is an autoimmune disease often characterized by malnutrition and linked to a number of complications such as increased risk of lymphoma, adverse pregnancy outcome and other autoimmune diseases. Tuberculosis (TB) affects a large proportion of the world population and is more common in individuals with malnutrition. We investigated the risk of TB in 14,335 individuals with CD and 69,888 matched reference individuals in a general population-based cohort study. Methods: We used Cox proportional hazards method to calculate the risk of subsequent TB in individuals with CD. In a separate analysis, we used conditional logistic regression to calculate the risk of CD in individuals with prior TB. Main results: CD was associated with an increased risk of subsequent TB (Hazard ratio = 3.74; 95% CI = 2.14 -6.53; p < 0.001). Similar risk estimates were seen when we stratified for sex and age at CD diagnosis. Individuals with CD were also at increased risk of TB diagnosed in departments of pulmonary medicine, infectious diseases, pediatrics or thoracic medicine (Hazard ratio = 4.76; 95% CI = 2.23-10.16; p < 0.001). The odds ratio for CD in individuals with prior TB is 2.50 (95% CI = 1.75-3.55; p < 0.001). Conclusions: CD is associated with TB. This may be due to malabsorption and lack of vitamin D in individuals with CD. Individuals with TB and gastrointestinal symptoms should be investigated for CD.

Keywords: autoimmune, coeliac, cohort study, lung disease, tuberculosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Coeliac disease and risk of tuberculosis: a population-based cohort study

D S Sanders, J West, and M K B Whyte
Thorax 2007 62: 1-2. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Ludvigsson, J F, Olen, O, Bell, M, Ekbom, A, Montgomery, S M (2008). Coeliac disease and risk of sepsis. Gut 57: 1074-1080 [Abstract] [Full Text]  
• Walters, J. R F, Bamford, K. B, Ghosh, S. (2008). Coeliac disease and the risk of infections. Gut 57: 1034-1035 [Full Text]  
• Sexton, P., Harrison, A. C. (2008). Susceptibility to nontuberculous mycobacterial lung disease. Eur Respir J 31: 1322-1333 [Abstract] [Full Text]