Pulmonary Medicine

Review Article

Prevalence of Latent Tuberculosis Infection in the Middle East and North Africa: A Systematic Review

Table 1

Study characteristics.
Study/reference numberDuration of studyYearCountryStudy populationTST and/or QFTStudy designSample sizeAge ()ToolsLTBIPrevalence (95% CI)Outcome
Nasehi et al. [31]October to December 20132016IranTB laboratory staff and low-risk healthcare workersTSTCross-sectional1006 and ANOVA, logistic regression79178.62% (75.96, 81.12)TB laboratory staff the OR of developing LTBI
Mamani et al. [32]March 2013, 6 months2016IranPrisonersTSTCross-sectional120818-60 yearsWilson procedure with continuity correction75662.58% (59.78, 65.32)High prevalence of LTBI
Bukhary et al. [33]December 20152018Saudi ArabiaHealthcare workers working in hajj pilgrimageTST QFT-GITCross-sectional52022-62 yearsStandardized questionnaire, chi-square test, Fisher exact test5610.76% (8.23, 13.75)Low prevalence of LTBI
Balkhy et al. [34]July 2010 to March 20132017Saudi ArabiaPrimary healthcare workersTST QFT-GITCross-sectional1369<15 to ≥65 yearsChi-square test, McNemar test14610.66% (9.07, 12.42)Low prevalence of LTBI
El-Helaly et al. [35]August 2009 to May 20112014Saudi ArabiaPreemployment screening of tertiary healthcare workersTST QFT-GITCross-sectional137218-60 yearsKappa coefficient, chi-square test42130.68% (28.25, 33.20)Fair agreement between TST and QFT-G tests
Hassan and Diab et al. [36]January to June 20122014Saudi ArabiaLaboratory personnel at a university hospitalQFT-GITCross-sectional13421-60 years ()Standardized questionnaire, chi-square test, Fisher’s exact test2619.4% (13.08, 27.12)Assessed risk factors involved with LTBI
Abbas et al. [37]January 2008 to December 20092010Saudi ArabiaHealthcare workers in tertiary care hospitalTSTCross-sectional265010 to >50 yearsANOVA29110.98% (9.81,12.23)Highest LTBI rates in physicians and nurses
Warrington et al. [38]January 20162018SyriaSyrian refugees entering CanadaQFT-GITCross-sectional995 to <50 yearsTwo-tailed independent -tests99.09% (4.24, 16.55)Low prevalence of LTBI. No active TB
Mekaini et al. [39]April to October 20132014UAEPediatric populationQFT-GITCross-sectional6691-19 yearsKruskal-Wallis one-way ANOVA, chi-square test, Fisher’s exact test30.44% (0.09, 1.30)Low prevalence of LTBI
Shitrit et al. [28]September and December 20022005IsraelHigh school students and adultsTSTCross-sectional84 yearsPearson correlation coefficient, Student’s -test5767.85% (56.77, 77.63)High prevalence of LTBI
Khamis et al. [40]January to June 20122016OmanHealthcare workers exposed to active TB in tertiary care hospitalTST QFT-GITCross-sectional29120 to 65 yearsDescriptive statistics12342.26% (36.52, 48.17)High prevalence of LTBI among healthcare workers
Garcell et al. [41]August 2012 to May 20132014QatarHealthcare workers in community hospitalTST QFT-GITCross-sectional202 yearsTest of independence, Student’s -test, and Wilcoxon Mann–Whitney146.93% (3.84, 11.35)Low prevalence of LTBI
Gunluoglu et al. [42]September to November 20112015TurkeyChronic renal failure patients undergoing regular hemodialysisTST QFT-GITCross-sectional44 (TST); 50 (QFT-GIT)62.2 years (mean age)Kappa statistic, Mann–Whitney -test, chi-square, Fisher’s exact test, Wilks’ lambda test16 (TST+); 27 (QFT-GIT+)50% (37.23, 62.76)High prevalence of LTBI
Duman et al. [43]Not available2014TurkeyPsoriasis patientsTST QFT-GITCross-sectional61 (psoriasis); 40 (psoriatic arthritis) yearsKolmogorov–Smirnov test, -test, Mann–Whitney -test, chi-square test, multivariable logistic regression, multiple linear regression52 (psoriasis); 29 (psoriatic arthritis)80.19% (71.08, 87.46)High prevalence of LTBI
Babayigit et al. [44]Not available2014TurkeyBCG vaccinated healthcare workersTST QFT-GITCross-sectional6421 to 51 years ()Kolmogorov-Smirnov test, Shapiro Wilk test, Mann–Whitney -test, Fisher exact test, Pearson chi-square test, logistic regression analysis3250% (37.23, 62.76)High prevalence of LTBI
Yilmaz et al. [29]Not available2012TurkeyPatients with systemic lupus erythematosusTST
QFT-GIT		Cross-sectional7813 to 67 yearsCohen’s kappa analysis, chi-square test, Mann–Whitney -test4152.56% (40.93, 63.99)High prevalence of LTBI
Hanta et al. [45]Not available2012TurkeyPatients with rheumatologic diseasesTST QFT-GITCross-sectional90 yearsChi-square test or Fisher’s exact test6673.33% (62.96, 82.10)High prevalence of LTBI
Soysal et al. [46]May 2006 to May 20072012TurkeyHemodialysis patientsTST T-SPOT.TBCross-sectional41119 to 84 yearsStudent’s -test, chi-square test or Fisher’s exact test, logistic regression analysis6114.84% (11.54, 18.65)Use of T-SPOT.TB in patients with negative TST for diagnosis of LTBI
Caglayan et al. [47]August 20052011TurkeyHealthcare workers of tertiary care hospitalTST QFT-GITCross-sectional78 yearsANOVA5975.64% (64.60, 84.65)High prevalence of LTBI
Karadag et al. [48]Not available2010TurkeyPatients with Takayasu arteritisTST
QFT-GIT		Cross-sectional94 yearsStudent’s -test, Wilcoxon rank-sum test, chi-square test, Fisher’s exact test5558.51% (47.88, 68.58)High prevalence of LTBI
Inanc et al. [49]March 2007 to June 20082009TurkeyPatients with rheumatoid arthritis and Ankylosing spondylitisTST QFT-GITCross-sectional140 yearsChen’s kappa analysis, Mann–Whitney -test, chi-square test8560.71% (52.11, 68.85)High prevalence of LTBI
Seyhan et al. [50]Not available2010TurkeyHemodialysis patientsTST QFT-GITCross-sectional100 yearsStudent -test, Mann–Whitney -test, chi-square test5656% (45.71, 65.91)High prevalence of LTBI
Hanta et al. [51]April 2005 to January 20082008TurkeyPatient with rheumatoid arthritis, ankylosing arthritis, and psoriatic arthritisTSTCross-sectional192 yearsFisher’s exact test12967.18% (60.05, 73.77)TST can be used for diagnosis of LTBI in rheumatologic disease before anti-TNF therapy.
Ozdemir et al. [52]June to August 20052007TurkeyHealthcare workers in Duzce University hospitalTST QFT-GITCross-sectional7618 to 50 years ()Cohen’s kappa, chi-square test, Student’s -test6788.15% (78.70, 94.44)High prevalence of LTBI
Bozkanat et al. [53]March 20082016TurkeyHealthcare workers in specialist tuberculosis hospitalTST QFT-GITCross-sectional34 yearsKappa test2367.64% (49.47, 82.61)High prevalence of LTBI
Hasanain et al. [54]December 2015 to January 20172018EgyptPatients with erectile dysfunctionTST QFT-GITCross-sectional97 yearsChi-square test, Fisher’s exact test2929.89% (21.02, 40.04)Prevalence of LTBI was high in patients with high-grade ED
El-Sokkary et al. [55]August 2012 to January 20132015EgyptHealthcare providersTST QFT-GITCross-sectional132 yearsChi-square test, Fisher’s exact test7859.09% (50.19, 67.56)High prevalence of LTBI
Slouma et al. [56]2007 to 20142017TunisiaPatients with chronic inflammatory diseases receiving biologic agents since at least 6 monthsTST QFT-GITCohort113 yearsStudent’s -test, ANOVA2320.35% (13.36, 28.95)Low prevalence of LTBI
Khazraiyan et al. [57]January to May 20132016IranHIV positive patientsTST QFT-GITCross-sectional13019 to 71 years ()Chi-square test, Fisher’s exact test3829.23% (21.58, 37.84)Low prevalence of LTBI
Jam et al. [30]January 2006 to February 20072010IranPatients with HIV/AIDSTSTCross-sectional2621 month to >60 yearsChi-square test6324.04% (19, 29.68)Medium prevalence of LTBI
Amiri et al. [58]June to August 20122014IranHomeless people of TehranQFT-GITCross-sectional593Not availableLogistic regression and chi-square test27746.71% (42.63,50.81)High prevalence of LTBI
[Overall prevalence 41.78% (31.18, 52.78)]
QFT-GIT: QuantiFERON-TB Gold In-Tube; TST: tuberculin skin test; LTBI: latent tuberculosis infection; OR: odds ratio; ANOVA: analysis of variance; HIV: human immunodeficiency virus; AIDS: acquired immunodeficiency syndrome; TNF: tumor necrosis factor.