DOI: http://dx.doi.org/10.18203/2349-3933.ijam20150552

Tuberculosis and diabetes: the deadly duo

Nageswara Rao Gopathi, Venu Mandava, Sravani Makala

Abstract


Background: With diabetes on the rise globally and with enormous pools of latent TB infection and high burdens of active disease in many countries, tuberculosis-diabetes is a looming co-epidemic. Furthermore, in countries where diabetes is escalating and tuberculosis rates are already high, diabetes will increasingly impede efforts to control tuberculosis.

Methods: A prospective study including fifty diabetic and fifty non diabetic sputum positive pulmonary tuberculosis patients was conducted for a period of one year. Thorough clinical examination, relevant investigations like blood sugars, chest X-ray, and smear for acid fast bacilli were done and results analyzed statistically.

Results: Though there is no significant difference in the clinical symptoms in both the groups, diabetic tuberculosis patients have prominent clinical severity at the onset, a greater degree of lung involvement and residual changes. There is predominance of lower zone involvement (56%) in diabetic patients and upper and mid zone involvement in non-diabetics. Extensive bilateral lesions and cavitations were more in diabetic patients. Sputum negativity after completion of intensive phase treatment was lower in diabetic patients compared to non-diabetics. Patients on insulin have better sputum conversion (94%) in comparison with oral hypoglycemic agents (76%). Relapse rate was high in diabetics (23.3%) compared to non-diabetics (8%).

Conclusions: Diabetes mellitus is growing rapidly worldwide and is increasingly fueling the spread of tuberculosis. Atypical presentations like lower lung field involvement and cavitations were common. Strict glycaemic control enhances the sputum clearance and results in better patient outcome.


Keywords


Acid fast bacilli, Diabetes mellitus, Oral hypoglycemic drugs, Lower lung filed tuberculosis

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References


Barach JH. Historical facts in Diabetes. Ann Med Hist. 1928;10:387.

Shamoon M, Hcndlci R, Sherwin R. Synergistic interaction among anti-insulin hormones in the pathogenesis of stress hyperglyccmia in humans J CIni Endocrinol Metab. 1981;52:1235.

National TB Statistics: TB facts 2014. Available at

http://www.tbfacts.org/tb-statistics.html. Accessed 1st may 2015.

Malin AS, McAdam KPWJ. Escalating threat from tuberculosis: the third epidemic. Thorax. 1995;50:37.

Stevenson CR, Critchley JA, Forouhi NG, Roglic G, Williams BG, Dye C, et al: Diabetes and the risk of tuberculosis: a neglected threat to public health Chronic Illn. 2007,3:228–45.

Geerlings SC, Hopelman AI: Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol. 1999;26:259–65.

McMahon MM, Bistrian Bruce R. Host defences and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am. 1995;9:1.

Mollcntzc WF, Pansegrouw DR, Stcyn AF. Diabetes mellitus, pulmonary tuberculosis and chronic calcific pancreatitis revisited. South Afr Med J. 1990,78:235.

Guptan A, Shah A: Tuberculosis and diabetes: an appraisal. Ind J Tub. 2000;47(3):2–8.

Smurova TF. Lung tuberculosis with associated diabetes mellitus. Excerpta Medico Chest Dis Thorac Surg Tuberc. 1980;37:660.

Sosman MC, Steidl JH. Diabetic tuberculosis. AJR. 1927:17;625.

Marias RM. Diabetes mellitus in black and coloured tuberculosis patients. South Afr Mcd J 1980;57:483.

Baghaei et al.: Diabetes mellitus and tuberculosis facts and controversies. Journal of Diabetes & Metabolic Disorders. 2013;12:58.

Niemi M, Backman JT, Fromm MF, Neuvonen PJ, Kivisto KT. Pharmacokinetic interactions with rifampicin: clinical relevance. Clin Pharmacokinet 2003;42:819–50.

Gwilt PR, Nahhas RR, Tracewell WG. The effects of diabetes mellitus on pharmacokinetics and pharmacodynamics in humans. Clin Pharmacokinet 1991;20:477–90.

Fisher-Hoch SP, Whitney E, McCormick JB, Crespo G, Smith B, Rahbar MH, et al. Type 2 diabetes and multidrug-resistant tuberculosis. Scand JInfect Dis. 2008;40(11-12):888–93.

Rodbard HW, Jelleinger PS, Davidson JA, et al. Statement by an AACE/ACEConsensus Panel on type 2 diabetes mellitus An algorithm for glycemiccontrol. Endocrine Practice. 2009;15(6):540–59.

American Thoracic Society, CDC, Infectious Diseases Society of America Treatment of tuberculosis. MMWR Recomm Rep. 2003;52:1–77.

Jeon CY, Harries AD, Baker MA, Hart JE, Kapur A, Lonnroth K, Ottmani SE, Goonesekera S, Murray MB: Bi-directional screening for tuberculosis and diabetes: a systematic review. Trop Med Int Health. 2010,15(11):1300–14.