Abstract
Introduction: The possible impact of ambient air pollution exposure on the development of active tuberculosis (TB) remains obscure. This study investigated the potential role of ambient air pollution in activating pulmonary TB (PTB) compared to extrapulmonary TB (EPTB). Materials and Methods: Data on TB cases were obtained from national surveillance data in Malaysia during 2013 and air pollution data were obtained from 52 air-monitoring stations around the country for the 3-year period of 2011-2013. Analyses were performed to estimate the odds of PTB vs. EPTB with changes in the 3-year (2011-2013) average Air Pollutant Index (API) and specific ambient air pollutants. Results: Results showed that the 95th-percentile of API levels during 2011-2013 was moderate and it was not associated with PTB. However, the odds of active PTB compared to EPTB was significantly elevated with the 95th-percentile levels for particulate matter with an aerodynamic diameter of 10 μm or less (aOR = 1.006, 95% CI: 1.002, 1.011), p-value < 0.01, and sulfur dioxide (aOR = 1.012, 95% CI: 1.006, 1.019), p-value < 0.01. Conclusions: These results provide suggestive evidence of the effects of ambient air pollution on development of active pulmonary TB compared to extrapulmonary TB. Additional research on the impacts of ambient air pollution on TB is warranted.
Highlights
The possible impact of ambient air pollution exposure on the development of active tuberculosis (TB) remains obscure
This study investigated the potential role of ambient air pollution in activating pulmonary TB (PTB) compared to extrapulmonary TB (EPTB)
To help identify potential role of ambient air pollution on incidence of PTB in Malaysia, we investigated ambient air pollution exposures that could activate the development of pulmonary compared to extrapulmonary TB disease
Summary
The possible impact of ambient air pollution exposure on the development of active tuberculosis (TB) remains obscure. This study investigated the potential role of ambient air pollution in activating pulmonary TB (PTB) compared to extrapulmonary TB (EPTB). Analyses were performed to estimate the odds of PTB vs EPTB with changes in the 3-year (2011-2013) average Air Pollutant Index (API) and specific ambient air pollutants. Conclusions: These results provide suggestive evidence of the effects of ambient air pollution on development of active pulmonary TB compared to extrapulmonary TB. Tuberculosis (TB) remains a major global health problem, significantly affecting millions of people each year, mostly from low and middle-income countries (LMICs) [1]. TB is an airborne infectious disease caused by the bacillus Mycobacterium tuberculosis, which spreads from a person with active TB infection to others through fine respiratory droplet nuclei. Extrapulmonary TB (EPTB) exists, in which the disease spreads beyond the lungs and affects other parts of the body, such as the brain, intestines, kidneys or spine; immunodeficient individuals and children are more susceptible than others to EPTB
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