{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T06:55:03Z","timestamp":1777272903621,"version":"3.51.4"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"us civilian research & development foundation","award":["USB1-31150-XX-13"],"award-info":[{"award-number":["USB1-31150-XX-13"]}]},{"DOI":"10.13039\/501100008982","name":"national science foundation","doi-asserted-by":"publisher","award":["Cooperative Agreement No. OISE-9531011"],"award-info":[{"award-number":["Cooperative Agreement No. OISE-9531011"]}],"id":[{"id":"10.13039\/501100008982","id-type":"DOI","asserted-by":"publisher"}]},{"name":"government of india\u2019s department of biotechnology"},{"DOI":"10.13039\/501100001411","name":"indian council of medical research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"name":"united states national institutes of health"},{"DOI":"10.13039\/100000060","name":"national institute of allergy and infectious diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006084","name":"office of aids research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Undernutrition impairs immunity to <jats:italic>Mycobacterium tuberculosis<\/jats:italic> and is a risk factor for tuberculosis disease (TB). We aim to investigate if severe undernutrition affects the tuberculin skin test (TST) response among household contacts (HHCs) of pulmonary TB cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed data from HHCs (&gt; five years) of pulmonary TB cases in Southern India. Undernutrition was defined as per World Health Organization based on body mass index (BMI) for adults (undernutrition 16\u201318.4 and severe undernutrition &lt;16 kg\/m<jats:sup>2<\/jats:sup>) and BMI relative to the mean for children (undernutrition 2SD-3SD and severe undernutrition &lt; 3SDs below mean). Univariate and multivariate models of TST positivity (&gt; five mm) were calculated using logistic regression with generalized estimating equations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 1189 HHCs, 342 were children (age 5\u201317 years) and 847 were adults. Prevalence of TST positivity in well-nourished, undernourished and severely undernourished children was 135\/251 (53.8%), 32\/68 (47.1%), and 7\/23 (30.4%) respectively; among adults, prevalence of TST positivity was 304\/708 (42.9%), 43\/112 (38.4%) and 12\/26 (46.2%), respectively. Severe undernutrition in children was associated with decreased odds of TST positivity (adjusted odds ratio 0.3; 95%CI 0.1\u20130.9).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Severe undernutrition in children was associated with decreased odds of TST positivity. False-negative TSTs may result from undernutrition; caution is warranted when interpreting negative results in undernourished populations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250304","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T17:43:23Z","timestamp":1626457403000},"page":"e0250304","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Severe undernutrition in children affects tuberculin skin test performance in Southern India"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6636-4438","authenticated-orcid":true,"given":"Divya","family":"Reddy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yicheng","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subitha","family":"Lakshminarayanan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swaroop","family":"Sahu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura F.","family":"White","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayiraveetil","family":"Reshma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gautam","family":"Roy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2245-3767","authenticated-orcid":true,"given":"Padmini","family":"Salgame","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selby","family":"Knudsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsie","family":"Cintron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerrold J.","family":"Ellner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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