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Factors changing the manifestation of pulmonary tuberculosis

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Abstract

To investigate factors altering the manifestation and outcome of pulmonary tuberculosis (PTB). The medical records of culture-proven TB patients from July 2001 through December 2002 were reviewed. A total of 461 patients were identified. Diabetes (21.5%) and malignancy (15.2%) were the most common underlying comorbidities. Sixteen cancer patients were initially misdiagnosed as pulmonary metastasis or recurrence. Younger patients frequently had constitutional symptoms and haemoptysis, while older patients frequently had respiratory symptoms and pleural effusion. Male predominance was noted, except in the 21-40-year-old non-diabetic group. Diabetic patients were more likely to present with cavitary nodules. Lower lung field TB was noted in 96 (20.8%) patients, and was associated with female sex and consolidative pattern. Factors associated with poor prognosis included underlying malignancy, chronic renal failure, serum albumin <35 g/l, and need for intensive care. Age influenced the manifestation of PTB. Diabetes mellitus was associated with a higher probability of cavitary nodules. TB should be considered in 21-40-year-old women with lower lung field consolidation. In cancer patients, pulmonary lesions should not be straightforwardly considered as metastasis or recurrence. The prognosis is poor for patients with underlying comorbidities, or in patients who need intensive

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... Several studies revealed that clinical features of TB do not vary amongst people with and without DM [49][50][51]. Few symptoms such as weight loss and fatigue are similar in both DM and TB patients. Chest radiographic examination of lung lesions revealed lesser extra-pulmonary involvement among patients with TB-DM comorbidity than in non-DM patients [46]. ...
... The higher incidence of lower lobe involvement among patients with TB-DM comorbidity has also been reported [54]. TB patients with uncontrolled DM (HbA 1c !7 [53 mmol/ mol]) are more commonly presented with cavitary lesions, particularly nodular lesions [51,55]. Few studies have shown no difference in terms of radiological manifestation between DM and non-DM cases [34,51]. ...
... TB patients with uncontrolled DM (HbA 1c !7 [53 mmol/ mol]) are more commonly presented with cavitary lesions, particularly nodular lesions [51,55]. Few studies have shown no difference in terms of radiological manifestation between DM and non-DM cases [34,51]. Furthermore, gender, advancing age and smoking status also affect the severity of pulmonary involvement in TB-DM patients. ...
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Despite significant efforts made to control tuberculosis (TB) through DOTS program, the increasing burden of diabetes mellitus (DM) threatens the progress in reducing TB-related mortality, particularly in developing countries. In recent years, TB-DM comorbidity continues to remain high in countries where DM is on rampant. DM increases the risk of TB, reactivates the dormant TB and worsens the TB treatment outcome. The present review highlights the current findings regarding the prevalence and association of TB-DM comorbidity along with their public health implications. This review will increase the awareness among researchers, policymakers and clinicians, regarding the current scenario of TB-DM association.
... " Notably, an inverse correlation was found between "CRP at entry" and the IgA titer for HrpA, and a positive correlation was revealed between "Albumin at entry" and IgA titers for ESAT-6 and Acr. These findings suggest that some IgA antibodies targeting mycobacterial antigens can protect against the bacterial expansion or replication and corresponding lung inflammation previously reported in murinestudies in vivo [23,[30][31][32] and that antibody production could be influenced by the nutritional status of the patients, as has been reported in many studies [33][34][35][36]. CMI induction of the Th1 response should be the center of the principal immunity to Mtb infection. ...
... We noted that the titers of some IgA antibodies were lower in active TB patients than in the controls, suggesting that BCG-induced humoral immunity to Mtb is maintained even after adolescence, but active disease can occur when the immunity diminishes. Several studies have also confirmed that vaccination with specific Mtb antigens such as Acr, Ag85, CFP-10, ESAT-6, or HBHA efficiently induces IgA and/or IgG antibodies as well as IFN-and other cytokines [35][36][37][38][39][40]. It is possible that DNA vaccination can induce humoral immunity in addition to CMI, which is important in protecting against the growth of Mtb. ...
... We also revealed that "CRP at entry" is a good surrogate marker for other clinical markers, a finding which is consistent with reports of previous studies [63]. Hypoalbuminemia has emerged as an independent factor of poor prognosis in several studies [33][34][35][36]. In this study, IgA antibody titers generated by certain Mtb-specific antigens were significantly correlated with the scores of clinical markers such as CRP or albumin levels at first admission, which appears to be one of the host immune responses against Mtb. ...
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Although tuberculosis remains a major global health problem, Bacille Calmette-Guérin (BCG) is the only available vaccine. However, BCG has limited applications, and a more effective vaccine is needed. Cellular mediated immunity (CMI) is thought to be the most important immune response for protection against Mycobacterium tuberculosis (Mtb). However, the recent failure of a clinical trial for a booster BCG vaccine and increasing evidence of antibody-mediated immunity prompted us to evaluate humoral immunity to Mtb-specific antigens. Using Enzyme-Linked ImmunoSpot and Enzyme-Linked ImmunoSorbent Assays, we observed less correlation of both CMI and IgG titers with patient clinical status, including serum concentration of C reactive protein. However, IgA titers against Mtb were significantly correlated with clinical status, suggesting that specific IgA antibodies protect against Mtb proliferation. In addition, in some cases, IgA antibody titers were significantly associated with the serum concentration of total albumin, which supports the idea that humoral immunity can be influenced by the nutritional status. Based on these observations, we propose that the induction of humoral immunity should be included as an option in TB vaccine development strategies.
... This disease is the fourth or fifth cause of death in developed countries [8]. the relationship between tuberculosis and diabetes has been introduced by Abu Ali Sina hundreds of years ago [10]. in 1950 and 1992, diabetes was proposed as a threatening factor in causing active tuberculosis in literature reviews [11]. The mechanism of cooperation is not much known but researchers believe that diabetes, through repressing immune responses and affecting bacteria-killing activities of white blood cells, activates the hidden infections of mycobacterium and the progress of the disease [12]. Also, tuberculosis infection is very prevalent among diabetic people [13]. ...
... In total, most of the radiological findings of the TB patients are like that of TB nondiabetic patients which is consistent with previous studies [8, 11,12,14], but it is not consistent with the findings of in previous study [30] that various fragmented and pitted distribution in bellows radiography in diabetic patients is more which its cause can be a good control of diabetics in the patients and lack of much effects on the process of tuberculosis [26]. ...
... Several studies indicated that DM increases the proportion of developing SP-PTB disease (as opposed to SN-PTB) among those who progress to pulmonary TB disease (Effect 5-Smear positivity) [51][52][53][54][55][56][57][58][59][60] . DM was also found to be a risk factor for increased M. tuberculosis bacterial load 51,54,61,62 ; a proxy biomarker for increased TB infectiousness among those with pulmonary TB disease (Effect 6-Disease infectiousness)-that is, DM increasing the risk of TB transmission per one respiratory contact as a consequence of the higher bacterial load. ...
... Strong evidence indicated that DM increases the risk of TB-related mortality among treated TB-disease individuals (Effect 7-TB mortality) 12,13,52,53,60,61,63 . We assumed, given biological plausibility, that the same effect applies for untreated TB disease individuals (Effect 7-TB mortality). ...
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We aimed to develop a conceptual framework of diabetes mellitus (DM) effects on tuberculosis (TB) natural history and treatment outcomes, and to assess the impact of these effects on TB-transmission dynamics. The model was calibrated using TB data for India. A conceptual framework was developed based on a literature review, and then translated into a mathematical model to assess the impact of the DM-on-TB effects. The impact was analyzed using TB-disease incidence hazard ratio (HR) and population attributable fraction (PAF) measures. Evidence was identified for 10 plausible DM-on-TB effects. Assuming a flat change of 300% (meaning an effect size of 3.0) for each DM-on-TB effect, the HR ranged between 1.0 (Effect 9-Recovery) and 2.7 (Effect 2-Fast progression); most effects did not have an impact on the HR. Meanwhile, TB-disease incidence attributed directly and indirectly to each effect ranged between −4.6% (Effect 7-TB mortality) and 34.5% (Effect 2-Fast progression). The second largest impact was for Effect 6-Disease infectiousness at 29.9%. In conclusion, DM can affect TB-transmission dynamics in multiple ways, most of which are poorly characterized and difficult to assess in epidemiologic studies. The indirect (e.g. onward transmission) impacts of some DM-on-TB effects are comparable in scale to the direct impacts. While the impact of several effects on the HR was limited, the impact on the PAF was substantial suggesting that DM could be impacting TB epidemiology to a larger extent than previously thought.
... Some authors found that age can influence clinical symptoms and radiographic manifestations, with less cavitation frequency in very advanced age or very young groups. Conversely, diabetes mellitus is associated with higher odds of having cavities (6). ...
... Values expressed as n (%); 2 OR: Odds ratio; 3 p: p value; 4 Hospitalized: patient who required hospitalization during treatment; 5 Rx: radiology;6 Extrapulmonary TB: includes exclusive extrapulmonary locations and mixed locations (pulmonary + extrapulmonary); 7 TB: tuberculosis; 8 Pleural TB: includes exclusive pleural locations and mixed locations (pleural + pulmonary); 9 SSM (+): positive sputum smear microscopy ...
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Introduction: Tuberculosis continues to be a major health problem in the world with an incidence of more than 10 million cases in 2015. There are factors that change the risk of developing the disease after infection, as well as the presentation of the disease. Objective: To determine the main comorbidities and demographic, clinical and microbiological characteristics of tuberculosis adult patients in Argentina from a gender and age perspective. Materials and methods: We conducted a cross-sectional study in urban referral hospitals for patients with tuberculosis. We included tuberculosis patients of 15 years or more of age who were hospitalized or treated in outpatient clinics with bacteriologically confirmed pulmonary or extrapulmonary forms of the disease, as well as those who, although not bacteriologically confirmed, had clinical and radiological characteristics consistent with tuberculosis. The study period was from August 1st, 2015 to August 31st, 2016. Results: We included 378 patients. The median age was 37 years. Male gender was associated with extrapulmonary tuberculosis, hospitalization, smoking, drug addiction and alcoholism. Tuberculosis and aids (22.6%) was related to drug use, admission into hospital, extrapulmonary tuberculosis, nonaddiction to tobacco, non-pathological radiology, absence of cavitation, and negative sputum smear microscopy. Patients less than 40 years of age had a higher rate of drug addiction and low weight, while those aged 40 or over had a higher proportion of diabetes, alcoholism and chronic obstructive pulmonary disease (COPD). Conclusions: This study will help recognize tuberculosis patients' characteristics and comorbidities influencing the development and evolution of the disease from an age and gender perspective to enable the development of social and community-based strategies.
... Hal ini serupa beberapa studi sebelumnya yang menyatakan bahwa DM berasosiasi dengan ditemukannya empat atau lebih gejala TB, diantaranya batuk, batuk berdahak, demam, batuk darah, lemah, rasa tidak nyaman di dada, nyeri dada, penurunan nafsu makan, berkeringat di malam hari, atau penurunan berat badan. 15,16 Akan tetapi sejumlah studi lainnya gagal memperlihatkan perbedaan gejala klinis TB diantara orang dengan DM dan tanpa DM. [17][18][19][20][21] Efek DM terhadap hasil pemeriksaan penunjang TB seperti foto toraks, BTA, kultur, dan resistensi juga masih diperdebatkan. Pada Registri TB-DM ini, abnormalitas foto toraks pada TB-DM secara bermakna lebih banyak ditemukan, temuan ini konsisten dengan sebuah studi di China tahun 2010-2012. ...
... 15 Pengaruh DM terhadap luaran pengobatan TB juga masih kontroversial, Beberapa studi gagal memperlihatkan hubungan tersebut. 17,19,20 Sebaliknya studi lain melaporkan kegagalan pengobatan TB 7,65 kali lebih tinggi dan kematian enam kali lebih tinggi pada TB dengan DM. 15,[24][25][26][27] Pada registri ini, kegagalan pengobatan (meninggal, putus berobat, gagal pengobatan, atau pindah) tiga kali lebih besar pada TD-DM dibanding TB-non DM. ...
... Previous studies have also shown the same pattern. Study done in Taiwan had shown LLFTB, which was usually associated with endobronchial lesions, developing more frequently in women [11]. Other studies from India and Cameroon also showed higher incidence of LLFTB in females as compared to males [12,13]. ...
... In another study chest radiographs of 150 patients of pulmonary TB with diabetes and observed that 69 (46%) films showed the typical pattern involving upper zone, while 81 (54%) films showed the atypical pattern with lower lung field involvement [24]. There were other studies also that showed a higher incidence of lower lobe involvement among diabetic tubercular cases [11,13,25,26], while the same trend of LLFTB in diabetes patients was not shown by others [27][28][29]. ...
Article
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Aim . To study the clinical and radiological features of lower lung field tuberculosis (LLFTB) in relation to the patients of nonlower lung field tuberculosis (non-LLFTB). Material and Methods . All the patients of lower lung field tuberculosis defined by the lesions below an arbitrary line across the hila in their chest X-rays were included in the study. Their sputum for acid fast bacilli, HIV, blood sugar, and other relevant investigations were performed. Results . The total of 2136 cases of pulmonary tuberculosis was studied. Among them 215 (10%) cases of patients were diagnosed as the case of lower lung field tuberculosis. Females (62%) were more commonly affected. Most common clinical feature in non-LLFTB was cough (69%) followed by fever (65%), chest pain (54.7%), and weight loss (54.4%). Chest X-ray showed predominance of right side (60.9%) in cases of LLFTB. The relative risk of having the LLFTB in diabetes patients, HIV seropositive patients, end stage renal disease patients, and patients on corticosteroid therapy was high. Conclusion . Lower lung field tuberculosis is not an uncommon entity. It is more common in diabetes, HIV positive, end stage renal disease, and corticosteroid treated patients. Clinical and radiological features are different from upper lobe tuberculosis patients.
... The development of cavitary lung lesions indicates the severe abnormality in the immune response during TB infection and could be associated with hyperglycaemia [30,38]. Two studies reported poor treatment outcomes (relapse, death or loss to followup) in patients with DM or hyperglycaemia at enrolment and one-year post-treatment follow-up [21,33]. ...
Article
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Background Hyperglycaemia is a risk factor for tuberculosis. Evidence of changes in blood glucose levels during and after tuberculosis treatment is unclear. Objective To compile evidence of changes in blood glucose during and after tuberculosis treatment and the effects of elevated blood glucose changes on treatment outcomes in previously normoglycaemic patients. Methods Original research studies (1980 to 2021) were identified in PubMed, Web of Science, CINAHL and Embase databases. Results Of the 1,277 articles extracted, 14 were included in the final review. All the studies were observational and 50% were prospective. Fasting blood sugar was the most common clinical test (64%), followed by the glycated haemoglobin test and the oral glucose tolerance test (each 50%). Most tests were conducted at baseline and in the third month of treatment. Twelve studies showed that the prevalence of hyperglycaemia in previously normoglycaemic patients decreased from baseline to follow-up and end of treatment. Three studies showed successful treatment outcomes of 64%, 75% and 95%. Patients with hyperglycaemia at baseline were more likely to develop cavitary lung lesions and poor treatment outcomes and had higher post-treatment mortality. There was no difference in outcomes by human immunodeficiency virus (HIV) status. Conclusion Elevated blood glucose in normoglycaemic patients receiving treatment for tuberculosis decreased by the end of treatment. Positive HIV status did not affect glucose changes during treatment. Further research is needed to investigate post-treatment morbidity in patients with baseline hyperglycaemia and the effects of HIV on the association between blood glucose and tuberculosis.
... Another factor associated with cavitary TB was previous pulmonary TB and diabetes mellitus. Several published comparative studies have revealed that cavitary disease occurs more frequently in patients with diabetes mellitus than in those without [15,18,19,32]. Consistent with these results, our study showed that diabetes mellitus is associated with cavitary TB. ...
Article
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Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.
... Factors that depend on the host play an important role in the prevalence of cavitation of tuberculosis. In patients with acquired immunodeficiency syndrome, cavitation is less frequent, 43,44 whereas cavitation is highly prevalent among diabetic patients with tuberculosis, 45 and multiple small, irregular cavities also have been reported on CT scans. 46 ...
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cavities in oncology patients
... COPD influences the clinical presentation of TB and is a risk factor for increased Access this article online Quick Response Code: Website: www.medpulse.in Accessed Date: 02 October 2020 morbidity and mortality from TB. [8][9][10][11][12][13][14][15] The use of steroids, physical and mental stress and poor socio economic status because of loss of wages due to asthma may predispose the patient to tuberculosis. Tobacco smoking is a major aetiological factor in the development of COPD. ...
... On the other hand, chest X-ray imaging is an appropriate method for initial assessment and follow-up of TB cases, as it enables the identification of radiological patterns suggestive of the disease, such as the pulmonary cavities caused by extensive caseous necrosis as a result of the pathogen's own action [27]. The relationship between the pathological process of lung cavitation and the development of MDR-TB has been reported in previous research [28,29], including the higher prevalence of this event in people who have TB and diabetes mellitus [30]. ...
Article
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Objective Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB. Methods Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian Spatial Hierarchical Analysis with a multilevel design was carried out. Results It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95%CI]:12.06‐15.93), positive sputum culture test (OR:5.26, 95%CI:4.44‐6.23), diabetes mellitus (OR:2.34, 95%CI:1.87‐2.91), residing at a standard address (OR:2.62, 95%CI:1.91‐3.60), positive sputum smear microscopy (OR:1.74, 95%CI:1.44‐2.12), cavitary pulmonary TB (OR:1.35, 95%CI:1.14‐1.60) and diagnosis performed due to spontaneous request (OR:1.26; 95%CI:1.10‐1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR:1.50, 95%CI:1.25‐1.79), that diagnosed TB cases only after death (OR:1.50, 95%CI:1.17‐1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR:1.56, 95%CI:1.30‐1.87) were also related to the MDR‐TB. Conclusions Knowledge of this predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.
... Low-cost diabetes testing is recommended, although the results may be slightly skewed, patients are more likely to agree that it is cheap. The laboratories or at the provider clinics provide these tests with the assurance of interventions to obtain data on diabetes screening as part of the TB surveillance system 14,15 . Integrated delivery units provide a solution for diabetes screening, TB diagnosis and TB-diabetes mellitus treatment in a facility that can capture data with supporting systems and monitoring results. ...
Article
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Tuberculosis (TB) is a bacterial infection caused by M. tuberculosis, also known as Mycobacterium Tuberculosis. There is a bidirectional relationship between TB and diabetes, and they both impact the presentation of each other. Diabetes is being increasingly recognized as a risk factor for TB. The expected rise in diabetes cases in developing countries having the brunt of tuberculosis would increase the influence of diabetes on TB in the coming future. The impact and relationship between TB and diabetes will vary across different regions of the world depending on the incidence and prevalence of each condition. Patient education is so important in understanding the disease nature (both TB and diabetes), duration of treatment, side effects of drugs, and complications of disease as well as the promotion of healthy lifestyle choices The objective of this review is to determine the prevalence, diagnostic and prevention strategy between diabetes mellitus and tuberculosis. The selected studies were identified using Pub Med database. The identified studies define lifestyle as important risk factor that may worsen the progression of the disease. This article also discussed about the prevalence of tuberculosis-diabetes mellitus over a span of 8 years.
... This phenomenon in turn can be partly responsible for high rate of TB in this region. [18][19][20][21][22] In this research, 80% of cases were pulmonary TB cases. ...
Article
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Introduction: Tuberculosis (TB) is a chronic disease which spreads through respiration and develops lesions in lung or other organs. The most usual kind of TB is pulmonary TB. The highest incidence rate of TB is in the eastern neighbors of Iran rendering high TB incidence in Sistan and Baluchistan province of Iran. The current research was conducted to investigate the epidemiology of TB in the north of the province, the Sistan region. Methods: In this survey, data of all suspected and established TB cases in the Zabol city was collected from their profiles in health care centers during 2010-2013. The trend of the disease, and its prevalence based on residency and gender were assessed. Results: In this period of time, a total of 1800 TB cases were detected. Of these, 485 (27%) were from urban areas and 1315 (73%) were from rural areas. The trend of TB identification increased with a slope of nearly 46.4. In this research, the most resistance to drug was related to Isoniazid and Rifampin and the least resistance was to ethambutol and streptomycin. Conclusion: Dust storms in this area because of successive droughts and other living conditions can make the region susceptible to TB disease. Therefore, people in this area, especially in rural regions, should be given sufficient education to be protected against this infection.
... It has been well documented that COPD patients are at high risk of developing pulmonary tuberculosis [42]. Further, it has been established that COPD is common morbidity after diabetes, in patients having TB [43,44]. Additionally, a negative impact has been reported of TB history on the long term course of COPD which results in early mortality and elevated exacerbations [45]. ...
Article
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Mycobacterium tuberculosis (Mtb) has coevolved with a human host to evade and exploit the immune system in multiple ways. Mtb is an enormously successful human pathogen that can remain undetected in hosts for decades without causing clinical disease. While tuberculosis (TB) represents a perfect prototype of host-pathogen interaction, it remains a major challenge to develop new therapies to combat mycobacterial infections. Additionally, recent studies emphasize on comorbidity of TB with different non-communicable diseases (NCDs), highlighting the impact of demographic and lifestyle changes on the global burden of TB. In the recent past, host-directed therapies have emerged as a novel and promising approach to treating TB. Drugs modulating host responses are likely to avoid the development of bacterial resistance which is a major public health concern for TB treatment. Interestingly, many of these drugs also form treatment strategies for non-communicable diseases. In general, technological advances along with novel host-directed therapies may open an exciting and promising research area, which can eventually deliver effective TB treatment as well as curtail the emergent synergy with NCDs.
... We also found that patients with DM in our study had more cavitary lesions. Our finding is in accordance with results of some previous studies, 22,24 and the reason proposed was due to uncontrolled glycemic level (HbA1c≥7) or insulin dependency. 9 However, we could not collect data of neither HbA1c levels nor insulin dependency. ...
Article
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Background: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study.
... Registrovan je manjak volumena plućne kapilarne mreže, zbog zahvaćenosti pluća dijabetesnom mikroangiopatijom, što dovodi do poremećenog odnosa ventilacije i perfuzije na štetu perfuzije u donjim režnjevima, porasta alveolarnog parcijalnog pritiska kiseonika, što pogoduje boljoj reprodukciji aerogenog Mycobacteriuma tuberculosis [11]. U literaturi postoji više studija koje nisu našle ni na kakvu razliku u radiografskoj distribuciji tuberkuloze kod pacijenata sa dijabetesom i bez dijabetesa, i odgovaraju i rezultatima naše studije [12,13]. Međutim, postoje i studije koje su pokazale atipičnu lokalizaciju tuberkuloze kod dijabetičara sa većom incidencom zahvatanja donjih režnjeva pluća [14,15]. ...
Article
Uvod. U svijetu se bilježi globalni porast oboljelih od tuberkuloze i dijabetesa.Bolesnici sa dijabetesom imaju dvostruko veći rizik oboljevanja od aktivnetuberkuloze, četiri puta veći rizik od recidiva tuberkuloze i dva puta većirizik od smrti tokom liječenja tuberkuloze. Cilj rada je utvrditi učestalostatipične radiološke lokalizacije tuberkuloze i učestalost komorbiditeta, kao ipotrebu za promjenom liječenja dijabetesa kod bolesnika sa tuberkulozom idijabetesom u odnosu na bolesnike bez dijabetesa.Metode. Ispitivane su dvije grupe bolesnika: grupu 1 činilo je trideset bolesnikasa tuberkulozom i dijabetesom, a grupu 2 trideset bolesnika sa tuberkulozombez dijabetesa. Retrospektivnom analizom medicinske dokumentacijebolesnika utvrđena je radiografska lokalizacija promjena na plućima, terapijadijabetesa, komorbiditeti i ishod liječenja.Rezultati. U grupi 1 na radiografiji pluća tipičnu rediografsku sliku i lokalizacijuplućne tuberkuloze je imalo 30%, a atipičnu lokalizaciju 70% bolesnika,dok je u grupi 2 tipična lokalizacija utvrđena kod 33,3%, a atipična kod66,7% bolesnika (p = 0,781). Prije prijema u bolnicu 60% bolesnika grupe 1 jeliječeno oralnim antidijabeticima, 13,3% insulinom, a 26,7% dijetom. Poslijeotpusta, oralnim antidijabeticima je liječeno 53,3% bolesnika, 36,7% insulinom,10% dijetom. Najčešći komorbiditeti u grupi 1 bile su kardiovaskularnebolesti (56,6%) i hronična opstruktivna bolest pluća (30,0%), a u grupi 2kardiovaskularne bolesti (33,3%), dok su hronična opstruktivna bolest plućai anemija bile zastupljene u istom procentu od 16,6%. Ishod liječenja bolesnikadvije ispitivane grupe značajno se razlikovao. U grupi 1 izliječena su24 bolesnika, a 6 bolesnika je umrlo, dok je u grupi 2 izliječeno 29, a umro 1bolesnik (p = 0,044).Zaključak. Nije utvrđena značajna razlika u učestalosti atipične radiološkelokalizacije tuberkuloze ni u učestalosti komorbiditeta kod bolesnika sa dijabetesomi onih bez dijabetesa. Bolesnici sa dijabetesom zahtijevali su tokomliječenja tuberkuloze korekciju liječenja dijabetesa. Utvrđen je statističkiznačajno veći broj umrlih bolesnika u grupi sa tuberkulozom i dijabetesomu odnosu na onu bez dijabetesa.
... [9] Our study results are reporting that 62% of the cases in PTB-DM group had cavitary lesions on CXR, a percentage much higher than 30% reported in the non-diabetic group. [10], [11] In the present study, 60% of cases had sputum positivity in DM-PTB group compared to 40% of cases with sputum positivity in non-DM PTB group. [12] In the present study, the cure rate was low and failure rate was high in the DM-PTB group compared to non-DM PTB group. ...
... Whilst it is not clear whether diabetes affects the presentation of TB, among diabetes patients, they tend to show more lower lobe involvement than their nondiabetic counterparts due to reactivation of old foci [8]. Again, some studies have reported lower rates of cavitation [12] whilst others reported higher rates [15][16][17]. TB associated with diabetes may also show higher rates of hemoptysis, fever, and atypical presentations compared with nondiabetics with TB [10,12,18]. ...
Article
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The burden of tuberculosis (TB) especially in developing countries continues to remain high despite efforts to improve preventive strategies. Known traditional risk factors for TB include poverty, malnutrition, overcrowding, and HIV/AIDS; however, diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Diabetes may also lead to severe disease, reactivation of dormant tuberculosis foci, and poor treatment outcomes. Tuberculosis as a disease entity on the other hand and some commonly used antituberculous medications separately may cause impaired glucose tolerance. This review seeks to highlight the impact of comorbid TB and diabetes on each other. It is our hope that this review will increase the awareness of clinicians and managers of TB and diabetes program on the effect of the interaction between these two disease entities and how to better screen and manage patients.
... [12,13] Hyperglycemia among people with TB is associated with more severe clinical manifestations during TB treatment like higher bacterial load in sputum, increased leucocyte count, increased acute phase response, more fever and atypical localization and cavity formation. [14][15][16][17][18][19] Glycemic control results in improvement in phagocytic activity [20], and avoidance of above-listed clinical complications. There is also evidence that enhanced management of DM reduces the risk of developing TB and improving TB treatment outcomes. ...
Article
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Background Stringent glycemic control by using insulin as a replacement or in addition to oral hypoglycemic agents (OHAs) has been recommended for people with tuberculosis and diabetes mellitus (TB-DM). This systematic review (PROSPERO 2016:CRD42016039101) analyses whether this improves TB treatment outcomes. Objectives Among people with drug-susceptible TB and DM on anti-TB treatment, to determine the effect of i) glycemic control (stringent or less stringent) compared to poor glycemic control and ii) insulin (only or with OHAs) compared to ‘OHAs only’ on unsuccessful TB treatment outcome(s). We looked for unfavourable TB treatment outcomes at the end of intensive phase and/or end of TB treatment (minimum six months and maximum 12 months follow up). Secondary outcomes were development of MDR-TB during the course of treatment, recurrence after 6 months and/or after 1 year post successful treatment completion and development of adverse events related to glucose lowering treatment (including hypoglycemic episodes). Methods All interventional studies (with comparison arm) and cohort studies on people with TB-DM on anti-TB treatment reporting glycemic control, DM treatment details and TB treatment outcomes were eligible. We searched electronic databases (EMBASE, PubMed, Google Scholar) and grey literature between 1996 and April 2017. Screening, data extraction and risk of bias assessment were done independently by two investigators and recourse to a third investigator, for resolution of differences. Results After removal of duplicates from 2326 identified articles, 2054 underwent title and abstract screening. Following full text screening of 56 articles, nine cohort studies were included. Considering high methodological and clinical heterogeneity, we decided to report the results qualitatively and not perform a meta-analysis. Eight studies dealt with glycemic control, of which only two were free of the risk of bias (with confounder-adjusted measures of effect). An Indian study reported 30% fewer unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64−0.81)) and 2.8 times higher odds of ‘no recurrence’ (aOR (0.95 CI): 2.83 (2.60−2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes. Conclusion We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.
... As recently reviewed, little is known about the prevalence of diabetes in TB burden countries [8] and none or little studies on the role of diabetes for TB have been carried out in Africa. In addition, a recent study in Taiwan, showed that diabetes was the most common underlying co-morbidity in patients with culture-confirmed TB, present in 21.5% of patients [9] and among patients afflicted with both TB and DM, diabetes was reported to be associated with poor TB treatment outcomes [10][11][12]. However, a systematic analysis to both clarify and quantify the association between DM and TB outcomes; especially in those with poor glycaemic control, including persistence of sputum conversion positive (2-month, 4-month and 6-month culture conversion rates), death and relapse, are poorly documented in low income countries precisely in Sub-Saharan area with high rates of infection with human immuno-deficiency virus (HIV) as a strong competing risk factor. ...
... for Taiwan, China: OR = 2.27, 95% CI: 1.74-2.96) [23,31] , and had a higher probability of cavitary nodules (19.2% vs. 8.8%, P = 0.028) [32] . ...
Article
Full-text available
China has a double burden of diabetes mellitus and tuberculosis, and many studies have been carried out on the mutual impact of these two diseases. This paper systematically reviewed studies conducted in China covering the mutual impact of epidemics of diabetes and tuberculosis, the impact of diabetes on multi-drug resistant tuberculosis and on the tuberculosis clinical manifestation and treatment outcome, the yields of bi-directional screening, and economic evaluation for tuberculosis screening among diabetes patients. © 2017 The Editorial Board of Biomedical and Environmental Sciences
... These studies demonstrated that diabetic PTB patients might exhibit an increased frequency of atypical features, including lower lobe disease [8,9], less reticulonodular opacities [10], and more extensive disease [9,[11][12][13]. In contrast, several studies revealed no obvious radiological differences between diabetic and non-diabetic PTB patients [10,[14][15][16]. A relatively small number of study cases, inconsistent consideration of the influence of age and gender and the effect of different glycemic control levels may partially explain the mixed results of these reported studies. ...
Article
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Setting: Diabetes mellitus (DM) may increase risk of pulmonary tuberculosis (PTB) and influence its radiological manifestations. Objective: To evaluate the impact of glycemic status on radiological findings of PTB in diabetic patients. Methods: Between January 2010 and December 2015, chest radiographs (CXRs) in consecutive 214 DM patients with culture-proved PTB and 123 available thoracic computed tomography (CT) scans were enrolled. An equal number of non-DM patients with similar demographics was included as the control group. Glycemic status was assessed by glycosylated hemoglobin (HbA1c), and a cutoff of 8% was used to further investigate radiological features of diabetic PTB. Two radiologists and one pulmonologist reviewed the chest images independently. Results: Compared with non-DM patients, primary PTB pattern and extensive disease on CXRs as well as primary PTB pattern, large non-cavitary nodule, more than one cavity in a single lesion, unusual location, and all lobe involvement of lesions on thoracic CT scans were more common in DM patients. Furthermore, diabetics with HbA1c > 8% were more likely to exhibit unusual findings (P < 0.001), far advanced extensive lesions (P < 0.001) on CXRs, lymphadenopathy (P = 0.028), more than one cavity in a single lesion (P < 0.001) and all lobe involvement (P = 0.041) on thoracic CT scans. Conclusions: Glycemic status influenced radiological manifestations of diabetic PTB. Given an increased risk of atypical radiological presentations of PTB in DM patients, physicians should be alert and pay more attention to those with poor glycemic control.
... Abbreviations: AFB -acid-fast bacilli, aHR -adjusted hazards ratio, DM -diabetes mellitus, E -ethambutol, ETB -extrapulmonary TB, HbA1c -glycated hemoglobin, H -isoniazid, OR -odds ratio, PTB -pulmonary TB, R rifampicin, S streptomycin, TB tuberculosis, and Z pyrazinamide. Wang, Lee, & Hsueh, 2005 TB treatment consisted of a standard regimen of daily HRZE for 2 months and HRE for another 4 months or daily HRE for 9 months.for 9 months. ...
Technical Report
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Tuberculosis (TB) remains one of the leading killers among bacterial diseases worldwide. In the Philippines, the prevalence of culture-positive TB is estimated to be 5 per 1000 and that for sputum smear-positive pulmonary TB is 2 per 1000 based on the 2007 National Prevalence Survey. In addition, the prevalence of metabolic syndrome among Filipinos is 5% or approximately 5 million people have diabetes (DM) in the Philippines. With the Philippines being endemic for TB, compounded by an upward trend of DM, there is a need to jointly address this tandem disease interaction. This study aims to mount a coordinated response to TB/DM with the following expectations: 1) improve the case detection rate for TB, 2) facilitate early management among patients, and 3) prevent a significant number of severe disease and deaths. A mixed methods are used to achieve the objectives including a systematic review and gray literature to estimate the magnitude of co-morbidity with TB and DM, records review specifically medical records on clinical charts of patients, cross-sectional survey on knowledge, attitudes and practices of health care providers on TB/DM screening and care, focus group discussions comprising of program managers and technical advisors of the National Tuberculosis Program, and costing exercise on bidirectional screening of TB in diabetic patients and vice-versa. Given the government’s commitment to the nationwide control of TB, the under-explored frontier of TB among diabetic patients can be among the stretch goals towards increased case detection, management and prevention efforts. Likewise, the increasing prevalence of diabetes in the country and the associated risk of TB transmission in a TBendemic population suggest the need for raising awareness on the need for TB screening. However, there is a body of programmatic and operational research questions to answer before an integrated approach to bidirectional screening can actually be implemented. Keywords: tuberculosis, diabetes mellitus, coordinated program response
... The current study demonstrated also that lower lobe involvement was found in 21.5% of DM-TB cases, similarly [26] stated that lower lobe involvement in DM-TB patients was 23% vs. 2.4% in non-DM TB patients (in his study on 692 TB patients in Saudi Arabia), also [21], on 320 TB patients in Mexico stated lower lung zone involvement was 29% in DM-TB vs. 3% in non-diabetics. However, there were other studies that did not find any difference between DM and non DM cases like [30] who found that lower lobe tuberculosis was 15.2% in DM-TB patients vs. 22.4% in non-diabetic TB patients (in his study on 461 patients in Taiwan). ...
Article
Full-text available
People with diabetes mellitus (DM) are at high risk of developing tuberculosis (TB) than those without. People with diabetes are more likely to fail treatment and to die during treatment compared to those without diabetes. Aim of the work: The aim of the current study was to study the risk factors for pulmonary tuberculosis among diabetic patients in comparison to patients with DM alone. Methods: 160 patients were grouped into two groups, the first group, 80 patients (DM-TB) group, and the second group, 80 patients, diabetics with chest diseases other than TB. All patients were subjected to meticulous history taking, clinical examination, radiological examination, and laboratory investigations. All data were statistically analyzed. Results: In this study the mean age of the DM-TB group was 52.90 ± 11.12 years and 54.57 ± 9.84 years for DM group. There was no statistically significant difference in gender, smoking, and DM treatment compliance between the two groups. There was a highly statistically significant difference in body mass index (BMI), Hashish, Banjo and Tramadol addiction, poor glycemic control, lower hemoglobin levels, platelet count, erythrocyte sedimentation rate and lower serum protein and albumin. Bilateral affection was found in 45% and 21.5% in lower lobe in DM-TB. Conclusion: From the current work it could be concluded that the factors determinant of pulmonary tuberculosis among diabetics are weight loss, decreased BMI, drug addiction, uncontrolled diabetes, higher rates of HbA1c, increased insulin requirements, anemia, higher ESR, higher platelet count and decreased serum proteins and albumin.
... Similarly, studies outside of the Middle East have supported the theory of worse glycemic control as a marker of disease severity predisposing to an increased rate of active TB disease among diabetics. [73][74][75] The aforementioned study from Iraq found glycated hemoglobin (HgbA1c) to be poorly controlled (>8%) in 48% of DM/TB patients. 29 No prospective studies were found that addressed how HgbA1c or another marker of DM disease control changed with successful TB treatment. ...
Article
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Objectives: Diabetes mellitus (DM) triples the risk of tuberculosis (TB) disease, complicates TB treatment, and increases the risk of a poor TB outcome. As DM prevalence is increasing across the Middle East, this review was performed to identify regional gaps in knowledge and research priorities for DM/TB. Methods: Online databases were searched for studies published from Middle East countries on DM and TB and the studies summarized based on topic and major findings. Studies included had a principle hypothesis related to both diseases, or described TB patients with individual data on DM. Results: Fifty-nine studies from 10 countries met search criteria. No published studies were found from Lebanon, Bahrain, Syria, Jordan, Cyprus, or the United Arab Emirates. DM prevalence among TB patients was high, but varied considerably across studies. The vast majority of studies were not specifically designed to compare DM/TB and non-DM/TB patients, but many suggested worse treatment outcomes for DM/TB, in accordance with reports from other regions. Conclusions: Opportunity exists for the regional study of bidirectional screening, management strategies for both DM and TB diseases, and whether such efforts could take place through the integration of services.
... Comparando los casos de TBC con y sin DM destaca la mayor edad en el primer grupo, con TBC pulmonar confirmada en mayor proporción con la bacteriología (lo que implica mayor contagiosidad). Se ha planteado en numerosos estudios que la DM podría determinar una entidad clínica tuberculosa diferente [33][34][35][36][37] . Si bien se pueden agregar algunas particularidades en las imágenes radiológicas, con lesiones más diseminadas y nódulos cavitarios que también incluyen las bases pulmonares 37 , alternativamente se puede postular que habría un diagnóstico tardío de tuberculosis, debido a la inusual sospecha de esta enfermedad entre los diabéticos y también en los adultos mayores, que frecuentemente tienen otras morbilidades. ...
Article
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Background: Diabetes mellitus (DM) could be an important factor in identifying people with a high risk of tuberculosis (TB) in Chile, thus, we aim at studying the force of the relationship of these two pathologies. Methods: A case-control study was undertaken using secondary data from the SSMS population group. The cases (n = 473) were defined as first episodes of confirmed TB patients 15 years and older, registered between 2006 and 2009. The controls (n = 507) were non TB cases, residents in the same Health Service area, randomly selected from the population registered under the public health care system. Risk factors were taken from SIGGES (system for health information and management) files. Logistic regression adjusting for age and social vulnerability was used to estimate the OR (± CI 95%). Results: The higher frequency of DM among cases OR = 3.3 (95% CI 2.2-5.0) was confirmed. The inclusion of confounders -age, health insurance and residence in poorer counties- in the model yields produced an adjusted OR = 2.3 (95%CI 1.5-3.6). Conclusions: DM is strongly associated with TB in Chilean settings, therefore it may be anticipated that adding this diabetes criteria in screening of TB would help to increase earlier and inclusive diagnosis.
... [20] Park et al reported that there was no difference in clinical symptoms between diabetics and non-diabetics and that patients with poor diabetic control were more likely to be smear positive compared with non-diabetes. [21] Most of these articles had a relatively small sample size and were not able to take covariates into account in assessing the association between DM and clinical manifestations of TB. [22][23][24] Our study enrolled more than 700 diabetic pulmonary TB patients and revealed that diabetic patients were significantly more likely to have any symptom, cough, hemoptysis, tiredness weight loss, positive smear and higher smear positivity grades as compared with non-diabetics after adjusting for covariates. Furthermore, the association between diabetes and clinical manifestations of pulmonary TB was related to glycemic control. ...
Article
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To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005-2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7-9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%-9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40-5.25) and HbA1C 7-9% (adjOR 1.62, 95% CI 1.07-2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70-1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19-5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89-4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344). Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.
... Previous data suggested that diabetes might be associated with increased frequency of cavitary lesion (ie, the highly infectious form of tuberculosis) in patients with tuberculosis. 26 In the present model, we assumed that patients with diabetes and tuberculosis were as infectious as patients with tuberculosis without diabetes because quantitative information about diff erential infectiousness was not available. Therefore our analysis could have underestimated the overall eff ect of diabetes on tuberculosis. ...
Article
Diabetes increases the risk of tuberculosis incidence and the risk of adverse treatment outcomes in patients with tuberculosis. Because prevalence of diabetes is increasing in low-income and middle-income countries where the burden of tuberculosis is high, prevention of diabetes carries the potential to improve tuberculosis control worldwide. We used dynamic tuberculosis transmission models to analyse the potential effect of diabetes on tuberculosis epidemiology in 13 countries with high tuberculosis burden. We used data for previous diabetes prevalence in each country and constructed scenarios to represent the potential ranges of future diabetes prevalence. The country-specific model was calibrated to the estimated trend of tuberculosis incidence. We estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes prevention. If the prevalence of diabetes continues to rise as it has been in the past decade in the 13 countries (base case scenario), by 2035, the cumulative reduction in tuberculosis incidence would be 8·8% (95% credible interval [CrI] 4·0-15·8) and mortality would be 34·0% (30·3-39·6). Lowering the prevalence of diabetes by an absolute level of 6·6-13·8% could accelerate the decline of tuberculosis incidence by an absolute level of 11·5-25·2% and tuberculosis mortality by 8·7-19·4%. Compared with the base case scenario, stopping the rise of diabetes would avoid 6·0 million (95% CrI 5·1-6·9) incident cases and 1·1 million (1·0-1·3) tuberculosis deaths in 13 countries during 20 years. If interventions reduce diabetes incidence by 35% by 2025, 7·8 million (6·7-9·0) tuberculosis cases and 1·5 million (1·3-1·7) tuberculosis deaths could be averted by 2035. The diabetes epidemic could substantially affect tuberculosis epidemiology in high burden countries. The communicable disease and non-communicable disease sectors need to move beyond conventional boundaries and link with each other to form a joint response to diabetes and tuberculosis. Taiwan National Science Council. Copyright © 2015 Elsevier Ltd. All rights reserved.
... However, this is not always the case. Some studies have shown no relationship between DM or poor glucose control and the outcome of TB treatment [19][20][21][22][23]. In a recent study in China, fasting blood glucose (FBG) was used to document DM status, and no association was found between TB treatment outcome and FBG [14]. ...
Article
Full-text available
Diabetes mellitus (DM) affects tuberculosis (TB) treatment outcomes, mostly by increasing recurrence, mortality and treatment failure. The objectives were to determine the pattern of change in glycosylated haemoglobin (HbA1c) level in new TB patients admitted to hospital at the start and 3-months after TB treatment, and to relate the measurements at these two time intervals to whether patients successfully completed treatment. A prospective cohort study was conducted on hospitalized new TB patients at Masih Daneshvari Hospital from 2012 to 2013. All patients were tested for HbA1c at the beginning and 3 months after initiation of TB treatment. Changes in HbA1c were compared to TB treatment outcome. There were 317 new TB cases admitted to hospital of which 158 had HbA1c at baseline and 3-months. Of these, 67 (42%) had normal values, 54 had an elevated HbA1c at either base-line or 3-months (uncertain diabetes status) and 37 (24%) had elevated HbA1c (≥6.5%) at both time points (DM). There were differences between the groups: those with DM were older, had a known history of DM and a higher prevalence of cavities on chest x-ray. There were 150 (95%) patients who successfully completed treatment with no significant differences between the groups. There were changes in HbA1c during the first three-months of anti-TB treatment, but these were not associated with differences in TB treatment outcomes. Transient hyperglycemia should be considered in TB patients and needs to be taken into account in planning care and management.
... similar results were shown by others. 17,30 Other imaging findings including parenchymal infiltration, frequency and location of cavity, nodular pattern and pleural effusion had similar rate in both groups of our patients; these data are supported by other studies. 18,[24][25] CONCLUSION Diabetic patients especially females are more prone to pulmonary tuberculosis with greater frequency of dyspnea, weight loss, hemoptysis and multilobar cavitary lesions in comparison to non diabetics. ...
Article
Objectives: To evaluate the effect of Diabetes Mellitus (DM) on clinical and diagnostic methods and radiological features of pulmonary TB, in comparison to non diabetic pulmonary TB patients, in Golestan province, Northeast of Iran. Methodology: In this retrospective cross-sectional study during 2004-2008, medical records of patients with definite diagnosis of pulmonary TB were reviewed. Demographic data, clinical & diagnostic method and radiological findings were studied. Radiological data and lung High Resolution computed tomographic scan (lung HRCT) were done by two different radiologists. After data entry into SPSS-16, Fischer's exact test and chi-square test were used to compare the two groups (TB with DM & without it). P-value <0.05 was considered significant. Results: Among 200 patients with pulmonary TB, 80 (40%) had TB and concurrent DM (PTDM group). The mean age of two groups was not significantly different. Coincidental TB and DM were seen significantly more in female (P-value< 0.01). There was a significant difference between the two groups as regards fever, dyspnea, weight loss and hemoptysis. Positive sputum smear was the most frequent diagnostic method in both groups (PT, PTDM), no significant difference was shown (P-value > 0.05). Multilobar cavities were significantly more reported in diabetics (p-value = 0.014). No statistical differences were seen between two groups radiologically. Conclusion: Tuberculosis could be more invasive in diabetic patients especially females hence they should be given more attention.
... Detection, treatment and management of smear-positive patients were recognized as key points for PTB control, implying that more attention needs to be paid to patients with both PTB and DM, given that more than half of smear-positive cases were in this group. Our findings showed higher frequency of cavities on chest radiographs in patients with DM, similar to findings from previous international studies [28,29]. Before the initiation of PTB treatment, patients with both PTB and DM presented more clinical symptoms, with five symptoms found to be statistically significant between TB patients with and without DM. ...
Article
SUMMARY Diabetes mellitus (DM) is currently known to be one of the risk factors for pulmonary tuberculosis (PTB) and the proportion of DM in PTB is rising along with the increased prevalence of DM in countries with high PTB burden. This study was designed to explore the impact of DM on clinical presentation and treatment outcome of PTB in China. In an urban setting in Beijing, 1126 PTB patients, 30·6% with positive sputum smear, registered in two PTB dispensaries from January 2010 to December 2011 were screened for DM and were followed up prospectively during PTB treatment. DM was observed in 16·2% of patients with PTB. PTB with DM appeared to be associated with older age and a higher proportion of re-treatment. On presentation, DM was associated with more severe PTB signs with higher proportions of smear positivity [odds ratio (OR) 2·533, 95% confidence interval (CI) 1·779-3·606], cavity (OR 2·253, 95% CI 1·549-3·276) and more symptoms (OR 1·779, 95% CI 1·176-2·690). DM was also associated with non-TB deaths (OR 5·580, 95% CI 2·182-14·270, P < 0·001) and treatment failure (OR 6·696, 95% CI 2·019-22·200, P = 0·002). In Beijing, the findings of this study underlined the need to perform early bi-directional screening programmes and explore the underlying mechanism for different treatment outcomes for PTB with DM.
Chapter
Apart from the accessibility of antitubercular therapy (ATT), tuberculosis (TB) emerged to be a chief cause of mortality around the world. The present ATT had a disadvantage of lengthy period that creates a problem of noncompliance in patients and growth of resistance. The greater price and delayed temperament of TB medication development coupled with low advantages lead to repurposing of complementary drugs which may contribute as an innovative pharmaceutical approach. Metformin has currently engrossed a major consideration as a host-directed adjunctive therapy (HDT) and has several complementary roles on cellular and molecular metabolism, immunity of host, and transcription of genes engaged in innate host responses to M. tuberculosis. It has an inhibitory effect on mitochondrial complex I and has been found to increase AMP/ATP ratio, with the help of a series of several pathways, and causes bacterial killing. This chapter would discuss in detail about the cellular and molecular mode of action of metformin including its impact on T helper cell 1 (TH1) along with trends which metformin demonstrates in reference to CD4+ and CD8+ cells. The necessity for adjunctive host-targeted therapy and the synergistic role of metformin with other antitubercular medications have been thoroughly debated. Novel strategy to fight drug-resistant TB in concurrence with future perspectives has been discussed in this chapter.
Article
Objective To assess the impact of metformin use on health‐related quality of life (HRQoL) in tuberculosis (TB) patients who are presented with type 2 diabetes mellitus (T2DM). Methodology In this community‐based prospective study, TB patients attending Hakeem Abdul Hameed Centenary Hospital, New Delhi (India) and had comorbidity of T2DM between April 2018 and July 2019 were enrolled. Patients were divided into metformin users and metformin non‐users on the basis of the presence of metformin in their routine as antidiabetic drug(s). HRQoL was determined using a validated TB‐specific tool (Dhingra and Rajpal‐12 scale ie, DR‐12) consists of symptom and socio‐psychological and exercise adaptation domains. The HRQoL scores were compared at pretreatment (1st visit), end of intensive phase (2nd visit) and end of treatment (3rd visit) between the two groups. Results A total of 120 patients were enrolled, of which 24 were excluded as they did not respond at follow‐up visits. Among the metformin users (n = 48) the mean age of patients was 47.56 years and 62.50% was males. Among the metformin non‐users (n = 48), the mean age of patients was 49.02 years and 54.10% was males. The baseline characteristics were similar in both groups except for the substance used history (P = .025), literacy level (P = .048) and BMI (P = .028). Metformin users demonstrated significant improvement in symptom scores (2nd visit: P < .001; 3rd visit: P = .001) and socio‐psychological and exercise adaptation scores (2nd visit: P < .0001; 3rd visit: P < .0001) as compared with metformin non‐users at 2nd visit and 3rd visit. Overall, scores were also found to be significantly improved in metformin users (2nd visit: P < .001; 3rd visit: P = .001). Conclusion Metformin therapy exerted favourable effects on HRQoL in patients with TB and T2DM and can be recommended as an adjuvant antitubercular drug in TB patients with co‐morbidity of T2DM, unless contraindicated.
Article
Mối liên quan giữa bệnh nhân mắc lao phổi và đái tháo đường đã được biết đến từ lâu. Nhiều nghiên cứu đã chỉ ra rằng đái tháo đường làm thay đổi những biểu hiện lâm sàng và Xquang của lao phổi. Tại Bệnh viện Lao và bệnh phổi Thái Nguyên cho tới nay vẫn chưa có nhiều nghiên cứu về vấn đề này; do đó, chúng tôi tiến hành nghiên cứu này với mục tiêu mô tả đặc điểm lâm sàng và cận lâm sàng của lao phổi ở bệnh nhân đái tháo đường type 2 với phương pháp nghiên cứu mô tả thiết kế cắt ngang, kết hợp hồi cứu và tiến cứu. Kết quả nghiên cứu cho thấy tuổi trung bình của bệnh nhân mắc lao phổi kèm đái tháo đường cao hơn 58 ± 13 tuổi so với bệnh nhân lao phổi đơn thuần (42,27 ± 18) (p= 0,001). Sốt nhẹ về chiều, rale rít, rale ngáy thấy nhiều hơn ở bệnh nhân lao phổi kèm đái tháo đường (p < 0,05), nhưng sụt cân thấy nhiều hơn ở nhóm lao phổi đơn thuần (p < 0,05). Tổn thương hang và tổn thương thùy giữa trên X-quang thấy nhiều hơn ở bệnh nhân lao phổi kèm đái tháo đường (lần lượt là 27,9% và 628%) so với bệnh nhân lao phổi đơn thuần (lần lượt là 6,5% và 43,5%).
Article
Diabetes has been associated with an increased risk of developing tuberculosis. The reasons related to the increased susceptibility to develop TB in type 2 diabetes mellitus (T2DM) individuals, has not been completely elucidated. However, this susceptibility has been attributed to several factors including failures and misfunctioning of the immune system. In the present study, we aimed to determine the role of anti-hyperglycemic drugs such as glyburide, insulin, and metformin to promote the killing of mycobacteria through the regulation of innate immune molecules such as host defense peptides (HDP) in lung epithelial cells and macrophages. Our results showed that metformin reduces bacillary loads in macrophages and lung epithelial cells which correlates with higher production of β-defensin-2, -3 and -4. Since β-defensins are crucial molecules for controlling M. tuberculosis growth, the present results suggest that the use of metformin would be the first choice in the treatment for T2DM2, in patients within tuberculosis-endemic areas.
Article
Background: Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-tuberculosis treatment effects in patients afflicted with both tuberculosis and DM. Methods: Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-tuberculosis treatment effects [sputum conversion rate (SCR) and tuberculosis focus absorption] in diabetic patients receiving treatment for tuberculosis. We used RevMan 5.3 software to analyze the data. Results: We included twelve studies of which five reported SCR at two months, seven reported the conversion at three months, and seven reported tuberculosis focus absorption. According to the five studies which reported two months-SCR, patients with diabetes and tuberculosis had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the two months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, an additional seven studies reporting three months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the twelve studies demonstrated that there were differences in tuberculosis focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79). Conclusion: HbA1c control levels influence the SCR at three months and the tuberculosis focus absorption at the end of the anti-tuberculosis intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.
Article
Pregnancy is associated with insulin resistance similar to that found in type 2 diabetes mellitus (DM). The prevalence of gestational diabetes mellitus (GDM) in key tuberculosis (TB) endemic countries, such as India and China, has been increasing rapidly in the last decade and may be higher in human immunodeficiency virus (HIV) infected women. Pregnancy is also an independent risk factor for developing active TB; however, little is known about the interaction of GDM, HIV and TB. We review the epidemiology and immunology of GDM, and significant research gaps in understanding the interactions between GDM, pregnancy, and TB in women living with and those without HIV.
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Background Studies on the influence of diabetes mellitus on the radiological presentation of pulmonary tuberculosis performed so far yielded inconsistent results. We aimed to summarize the relevant evidence on this topic systematically. Methods We systematically searched PubMed/MEDLINE (1980–2016) and the references of related articles (English-language reports) for observational studies that compared the radiological presentation of pulmonary tuberculosis in diabetes and non-diabetes patients. Results A total of fifteen studies that enrolled 2,020 diabetic patients and 5,280 controls were included in this systematic review. None of the included studies showed any significant difference in the upper lobe involvement and or in bilateral disease between diabetes and non-diabetes patients. However, lower lung field cavitary disease was found to be more frequent (relative risks ranging from 2.76, 95% CI 2.28-3.35 to 4.47, 95% CI 2.62-7.62) in patients with poor glycemic control (HbA1C >9%). Similarly, a significantly higher proportion of cavitary disease in diabetes patients was reported by 7 out of 15 studies, the meta-analysis of cavities of any size/site also showed the significantly higher risk of cavitary disease in diabetes patients (p-value = 0.0008). Three studies stratified the presence of cavities by diabetes control status, finding a higher proportion of cavities in uncontrolled diabetic patients (relative risks ranging from 1.85, 95%CI 1.34-2.55 to 3.59, 95%CI 2.53-5.11). One out of four studies found a significantly higher proportion of nodular infiltrations in diabetes versus non-diabetes patients. Conclusion While there is no difference in localization of lung lesions between patients with diabetes and non-diabetes, our review found that the risk of cavitary disease is relatively higher in diabetes patients. It is essential for researchers to unify the criteria for diabetes diagnosis, patient selection, and radiographic severity and stratify the results by the potentially confounding factors.
Article
Background: Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB). The aim of this study was to evaluate the effect of DM on clinical presentation and treatment response of sputum positive pulmonary tuberculosis patients.Methods: The present retrospective study was carried out in department of Pulmonary Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, between January 2014 to December 2016.Results: Out of 205 subjects enrolled for this study, 73 were diagnosed with DM and 132 patients had no history of DM and were having HbA1c less than 6.5%. Mean HbA1c in DM group at presentation was 10.5 and in patients without DM group was 5.6. Low BMI was more in DM patients. Clinical characteristics at presentation were similar in both the groups. Patients with DM presented after long duration of symptoms (>8 weeks duration) and also with more atypical symptoms. On radiological examination, lower zone involvement and cavity lesions were more in patients with DM which was statistically significant. Clinical picture at the end of 6 months showed improvement in both the groups but radiological improvement was more in patients without DM compared to the other group.Conclusions: Uncontrolled DM is associated with high prevalence of Tuberculosis. Atypical symptoms and atypical radiological findings are more common in DM patients which lead to delayed presentation. Strategies are needed to ensure that optimal care is provided to patients with both diseases.
Chapter
People with diabetes develop infections more often than those without diabetes and the course of the infections is also more complicated. Historically, infections have been well recognized as an important cause of death in diabetes and remain a very important cause of morbidity and mortality Some infections that occur predominantly in people with diabetes, are uncommon and inevitably have limited data. Examples include malignant otitis externa, mucormycosis, emphysematous forms of cholecystitis, cystitis and pyelonephritis, and Fournier gangrene. This chapter describes specific infections either strongly associated with diabetes or in which the presence of diabetes is important, and explores principles of treatment, prevention, and general care.
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Objective: The aim of this study was to discuss the radiographic manifestations of type-II diabetes mellitus (DM) in patients with caseous tuberculosis (TB). Methods: We performed a retrospective analysis of the chest radiographs and CT scans of 18 type-II diabetic patients with caseous tuberculosis, treated at Zhongnan Hospital, from January 1997 to December 2012. Results: Eighteen cases of type-II diabetic patients with caseous tuberculosis (DMTB) showed different degrees of cough, cough phlegm and hemoptysis. Imaging performance: All eighteen cases showed big flake and multiple small pieces of integration high-density shadows. All showed caseous pneumonia, and two cases also showed atelectasis. CT examination revealed a number of small hollows in the lesions. Fourteen cases of the lesions were in the right lung, one in the left lung, and three cases in the bilateral lungs. Six cases were confirmed after Sputum examination or bronchoscopy, eight cases were confirmed one month later with a variety of ineffective treatments, and the rest were confirmed through operation. Conclusion: Type-II diabetic patients with caseous tuberculosis mainly showed consolidation and atypical lung field lesions on chest radiographs. Becoming familiar with these features will be helpful to imaging diagnosis of DMTB.
Article
The disease burden from tuberculosis (TB) and diabetes mellitus (DM) is increasing globally. Current evidence suggests that DM increases the odds of developing TB. This risk is highest in the low- and middle-income countries, where the burden of TB is high. Immune dysfunction due to DM increases the propensity to develop TB. Both DM and TB complicate each other and present enormous clinical challenges. This review article discusses the close interaction between the 2 comorbidities and also advocate for consideration of integration of dual-screening strategies for DM and TB in clinical care especially in areas with high prevalence of both diseases.
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The association between diabetes and incidence of tuberculosis is well established, and observational studies have shown poor treatment outcome in tuberculosis related to hyperglycemia. The WHO recommends screening for diabetes among all patients with tuberculosis and optimized glycemic control aiming at improving tuberculosis outcome. However, no intervention studies support this notion. Patients with tuberculosis are often vulnerable with high degree of comorbidity, and, therefore, at high risk of adverse effects of intensive glucose control. Controlled intervention studies of the effect of glucose lowering treatment on tuberculosis outcomes are clearly warranted to justify screening for- and tight control of diabetes.
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We investigated the effects of diabetes and the presence of lung cavities on treatment outcomes in patients with pulmonary tuberculosis. We conducted a retrospective review of the clinical records of all consecutive patients admitted to the Kanagawa Cardiovascular and Respiratory Centre with the diagnosis of pulmonary tuberculosis. The study outcomes examined were time to sputum culture conversion and percentage of patients with sputum culture conversion by the time 2 months of treatment had been completed, and these outcomes were compared between patients with and without diabetes. Of the 260 patients enrolled in the study, 69 were diagnosed as having diabetes mellitus, while the remaining 191 did not have diabetes. The percentage of patients with cavities was higher in the patients with diabetes (71.0%) than in those without (45.5%; P = 0.0003). The time to sputum culture conversion was significantly longer in the patients with diabetes than in those without (P = 0.0005), and the percentage of patients with a positive sputum culture at 2 months was higher in the patients with diabetes (43.5%) than in those without (18.8%; P = 0.0001). Multivariate analyses revealed that the presence/absence of lung cavities was a more important determinant of treatment outcomes than the presence/absence of diabetes. The presence of lung cavities was found to be a more important determinant of the treatment outcomes than that of diabetes per se in patients with pulmonary tuberculosis. This article is protected by copyright. All rights reserved.
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Patients with HIV infection have atypical clinical features of pulmonary tuberculosis; however, our knowledge on how malnutrition affects the clinical presentation is limited. We studied the influence of malnutrition and HIV infection on the clinical and radiological features of pulmonary tuberculosis (TB). We studied 239 consecutive acid fast bacillus-positive adult patients. Patients were investigated by clinical, radiological, anthropometric and laboratory methods. 78% of the patients were malnourished (BMI < 18.5) and 43% were severely malnourished (BMI < 16). 20% were HIV-positive. HIV-positive TB had significantly more oral candidiasis (OR = 3.72), diarrhoea (OR = 2.71), generalized lymphadenopathy (OR = 2.63), skin disorders (OR = 2.27), neuropsychiatric illness (OR = 2.44), hilar lymphadenopathy (OR = 2.07), but less cavitation (OR = 0.64) and upper lung lobe involvement (OR = 0.70). HIV-negative and severe malnourished patients presented more often with dyspnoea (OR = 1.44), diarrhoea (OR = 1.64), night sweat (OR = 1.83), and less with haemoptysis (OR = 0.58) and cavitation (OR = 0.64). The size of Mantoux was associated with HIV infection and malnutrition. In a logistic regression analysis both HIV status and malnutrition were associated with atypical presentation of pulmonary tuberculosis. Malnutrition and HIV infection both contribute for atypical presentation of pulmonary tuberculosis. The risk of such atypical presentation is particularly high among the severely malnourished HIV-infected patients.
Article
Review of patients with active pulmonary tuberculosis over a three-year period showed an increased incidence of bronchogenic carcinoma (5%). There had been considerable delay in establishing diagnosis of coexistent carcinoma which was attributed to finding of acid-fast bacilli and relative ease of ascribing all findings to that cause. Suspicious roentgen signs are reviewed and the importance of sputum cytology is also stressed.
,, h the lower lobe. It was not until the 1920stat the influx of reports became more apparent and informative (3-6). With the use of posteroante­ rior and lateral roentgenograms, the terminology about the loc~tion of the lesions became more specific, and ias late as 1946 some writers used the term "basal tuberculosis." The terms "lower lobe tuberculosis" and "lower lung field tuber­ culosis" have seen more usage recently. It is here that the writers wish to explain why the over-all heading of lower lung field tuber­ culosis was chosen, and what is meant by this terminology. The lower lung fields are considered that area on a posteroanterior chest film that ex­ tends below an imaginary horizontal line traced across the hila and including the parahilar re­ gions. In the early part of this study, in the 1930's and early 1940's, lateral films were taken so infrequently that the exact topographic loca­ tion of the lesion was difficult; therefore, the term lower lung field tuberculosis is preferred. Those patients selected in the last 20 years had lower 10be disease which was confirmed by lateral films and/or topographic studies.
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In the developing world, the diagnosis of tuberculosis is dependent on clinical and radiologic features as culture facilities are not readily available. It has been reported that tuberculosis in HIV-positive persons can present with atypical clinical and radiographic features. The object of this study was to examine how often atypical features occur in HIV-positive compared with HIV-negative persons and how these findings correspond to sputum-smear findings. Detailed demographic, clinical, and chest radiographic features of tuberculosis were assessed in 202 HIV-positive adults and 220 HIV-negative patients admitted consecutively. Using univariate analysis, several of these features were found to be significantly associated with being HIV-positive, but after multiple regression analysis only, age group (15 to 42 yr), a negative tuberculin response, intrathoracic lymphadenopathy, and lack of cavitation but not sputum-smear status remained significant.
Article
Two hundred and six standard PA chest X-rays were measured. The mean diameter of the left main bronchus (LMB) was 12.6±1.9 mm. The mean diameter of the 92 male LMB was 13.0±2.6, and for females 11.8±1.6. These data correspond closely to that reported by others. The correlation between the diameter of the LMB and that of the trachea was 0.74 but was not precise enough to be useful as an estimate for clinical use. Similarly there was good correlation between the diameter of the right main bronchus and that of the left (r=0.75) but not precise enough to be clinically useful. In contrast to previous claims, only direct measurement of the left main bronchus has sufficient precision to define the appropriate size of left double-lumen tube to be selected for lung separation.
Article
Socio-cultural factors have been invoked to explain the male predominance among patients with pulmonary tuberculosis, but there is no conclusive evidence of their role. To assess male predominance in a group of diabetics with pulmonary tuberculosis compared with patients with pulmonary tuberculosis alone. Clinical records of in-patients with pulmonary tuberculosis and with (TBDM group, n = 202) or without (TB group, n = 226) diabetes mellitus were reviewed, and the male percentages in each of six age groups (15-29, 30-39, 40-49, 50-59, 60-69, > or = 70 years) calculated. In the TB group, no gender difference (51% males) was found in the first age period, followed by a male predominance thereafter (71%, 68%, 75%, 63% and 58%). The TBDM group showed a similar pattern in the first two age groups (56% and 74%), followed by a steadily decline (r(S) = -0.90, P = 0.04) in male percentage (60%, 44%, 45%, 27%), leading to a female predominance after age 50. The association of age and gender was also corroborated by logistic regression in TBDM (P = 0.02), but not in TB (P = 0.19) patients. Diabetes was associated with a progressive shift of male predominance in pulmonary tuberculosis. Because diabetes is a disease that affects social activities similarly in men and women, our results suggest that factors other than socio-cultural ones are also important for determining the male predominance in pulmonary tuberculosis.