Title: Co-Morbidity of Pulmonary Tuberculosis and Diabetes Mellitus-A Prospective Analysis

Authors: Dr Ajith Kumar.M.K, Dr Rajani.M, Dr Manoj.D.K, Dr Saraladevi.A., Dr Achuthan.V

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i3.52

Abstract

Several studies have evaluated the relationship between diabetes mellitus (DM) and tuberculosis (TB), but the nature of this relationship is not fully understood. TB incidence may be influenced by immune suppression from DM, but this association may be confounded by other clinical and socioeconomic factors. We aimed to assess socio-demographic and clinical differences in TB patients with and without DM.A semi- Structured Proforma was used to collect the socio-demographic profile & clinical features, including the age, the sex, the site of the tuberculous pulmonary involvement seen on the chest roentgenogram of the patients. A fasting value >/= 129 mg/ dl & 2hrPPBS >/= 200 mg/ dl was considered as diabetes mellitus. Comparison of the clinical features was conducted after dividing them to 2 groups: - namely Group A (patients with sputum AFB positive tuberculosis and diabetes mellitus) & Group B (patients with sputum AFB positive tuberculosis without diabetes. Males were more affected than females. Most common age group  affected was 51-60(52.05%). Out of 73 patients, 49 (67.1%) had the history of contact with tuberculosis. The presence of diabetes mellitus was found not to have a statistically significant effect on the patients’ symptoms. DM and TB represent a critical intersection between communicable and non-communicable diseases in these countries and the effect of DM on TB incidence and outcomes provide numerous opportunities for collaboration and management of these complex diseases in the national public health programs.

Keywords: Diabetes Melitus, Tuberculosis

References

1.      Hassan Zadeh J, Nasehi M, Rezaianzadeh A, Tabatabaee H, Rajaeifard A, Ghaderi E. Pattern of reported tuberculosis cases in iran 2009-2010. Iran J Public Health. 2013;42(1):72–8.

2.      World Health Organization. Global tuberculosis control: WHO report 2011. Geneva: WHO; 2011.

3.      World Health Organization. Diabetes. Fact sheet No. 312. Geneva: WHO; 2011. 3 Baker, M.A., Lin, H.H., Chang,

4.      H.Y., and Murray, MB. The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study. Clin Infect Dis. 2012; 54: 818–825

5.      Dooley, K.E. and Chaisson, R.E. Tuberculosis and diabetes mellitus: convergence of two epidemics.Lancet Infect Dis. 2009; 9: 737–746

6.      Jeon, C.Y. and Murray, M.B. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008; 5: e152

7.      Lonnroth, K., Castro, K.G., Chakaya, J.M., Chauhan, L.S., Floyd, K., Glaziou, P., and Raviglione, M.C.Tuberculosis control and elimination 2010-50: cure, care, and social development. Lancet. 2010; 375:1814–1829

8.      International Diabetes Federation.  International Diabetes Federation diabetes atlas. 4th ed. IDF, Brussels; 2009

9.      Magee, M.J., Blumberg, H.M., and Narayan, K.M. Commentary: Co-occurrence of tuberculosis and diabetes: new paradigm of epidemiological transition. Int J Epidemiol. 2011; 40: 428–431

10.  Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.

11.  Deerochanawong C, Ferrario A. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes. Global Health. 2013;9:11. doi: 10.1186/1744-8603-9-11.

12.  World Health Organization. Non-communicable diseases country profile. Geneva Switzerland: WHO; 2010. Available from7. Esteghamati A, Ashraf H, Khalilzadeh O, Rashidi A, Mohammad K, Asgari F, et al. Trends of diabetes according to body mass index levels in Iran: results of the national Surveys of Risk Factors of Non-Communicable Diseases (1999-2007). Diabet Med. 2010;27(11):1233–40. doi: 10.1111/j.1464-5491.2010.03103.x.

13.  Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997;14(1):29–34. doi: 10.1002/(SICI)1096-9136(199701) 14:1<29::AID-DIA300>3.0.CO;2-V.

14.  McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am. 1995;9(1):1–9.

15.  Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH. Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am J Respir Crit Care Med. 2000;162(5):1738–40. doi: 10.1164/ajrccm.162.5.2001040.

16.  Ezung T, Devi NT, Singh NT, Singh TB. Pulmonary tuberculosis and diabetes mellitus--a study. J Indian Med Assoc. 2002;100(6):376. 378-9.

17.  Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7) doi: 10.1371/journal.pmed.0050152.

18.  Alavi SM, Salami N. The causes of death among patients with tuberculosis in Khuzestan, Iran. Pak J Med Sci. 2008;24(2):217–20.

19.  Duangrithi D, Thanachartwet V, Desakorn V, Jitruckthai P, Phojanamongkolkij K, Rienthong S, et al. Impact of diabetes mellitus on clinical parameters and treatment outcomes of newly diagnosed pulmonary tuberculosis patients in Thailand. Int J Clin Pract. 2013;67(11):1199–209. doi: 10.1111/ijcp.12215.

20.  Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 2007; 7:234. doi: 10.1186/1471-2458-7-234.

21.  Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest. 2001;120(5):1514–9

22.  Jabbar A, Hussain SF, Khan AA. Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with co-existing diabetes mellitus. East Mediterr Health J. 2006;12(5):522–7.

23.  Fitzgerald D, Hass W. Mycobacterium tuberculosis. In: Mandell G, Bennett J, Raphael D, editors. Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone; 2010. pp. 3129–51

24.  Seyed Mohammad Alavi,1,* Mohammad Mehdi Khoshkho,2 Shokrolah Salmanzadeh,3 and Mehdi Eghtesad Comparison of Epidemiological, Clinical, Laboratory and Radiological Features of Hospitalized Diabetic and Non-Diabetic Patients With Pulmonary Tuberculosis at Razi Hospital in AhvazJundishapur J Microbiol. 2014 Sep; 7(9): e12447. Published online 2014 Sep 1. doi:  10.5812/jjm.12447

25.  Pablos-Mendez A, Blustein J. Knirsch C. Thr role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. Am J Public Health 1997:87:574-579.

26.  Chen L, Magliano DJ, Zimmet PZ (2012) The worldwide epidemiology of type 2 diabetes mellitus–present and future perspectives. Nat Rev Endocrinol 8: 228–236

27.  Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, et al. (2011) National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 378: 31–40 

28.  Stalenhoef JE, Alisjahbana B, Nelwan EJ, van der Ven-Jongekrijg J, Ottenhoff TH, et al. (2008) The role of interferon-gamma in the increased tuberculosis risk in type 2 diabetes mellitus. Eur J Clin Microbiol Infect Dis 27: 97–103 

29.  Shaw JE, Sicree RA, Zimmet PZ (2010) Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 87: 4–14 

30.  Kelly T, Yang W, Chen CS, Reynolds K, He J (2008) Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 32: 1431–1437

31.  World Health Organization (2011) Tuberculosis & Diabetes. Collaborative Framework for care and control of tuberculosis and diabetes. Geneva: World Health Organization.

32.  Ponce-De-Leon A, Garcia-Garcia Md Mde L, Garcia-Sancho MC, Gomez-Perez FJ, Valdespino-Gomez JL, et al. (2004) Tuberculosis and diabetes in southern Mexico.Diabetes Care 27: 1584–1590 

33.  Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, et al. (2007) Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health 7: 234. 

34.  Mugusi F, Swai AB, Alberti KG, McLarty DG (1990) Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania. Tubercle 71: 271–276 

35.  Dyck RF, Klomp H, Marciniuk DD, Tan L, Stang MR, et al. (2007) The relationship between diabetes and tuberculosis in Saskatchewan: comparison of registered Indians and other Saskatchewan people. Can J Public Health 98: 55–59 [PubMed]

36.  Vasankari T, Holmstrom P, Ollgren J, Liippo K, Kokki M, et al. (2007) Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC Public Health 7: 291. 

37.  Kirn SJ, Hong YP, Lew WJ et al. Incidence of pulmonary tuberculosis among diabetics. Tubercle Lung Dis 1995, 76: 529

38.  Raviglione MC, Snider DE, Jr, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA 1995; 273:220-226.

39.  Ezung T, Devi NT, Singh NT, Singh TB. Pulmonary tuberculosis and diabetes mellitus-a   study. J. Of Indian Medical Association. 2002, 100(6): 376-379

40.  Feza Bacakoglu, Özen Kaçmaz Basoglu, Gürsel Çok, Abdullah Sayiner, Mahmut Ates, Pulmonary Tuberculosis in Patients with Diabetes mellitus, Respiration 2001; 68:595-600

41.  Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 2007;7:234. doi: 10.1186/1471-2458-7-234 

42.  Sheikh MA, Singla R, Khan NB, Sharif NS, Saigh MO,Does diabetes alter the radiological presentation of pulmonary tuberculosis. Saudi Med J. 2003 Mar; 24(3): 278-81.

43.  Sosman MC, Steidl JH. Diabetic tuberculosis. Am J Roentgenol 1927; 17: 625

44.  Weaver R. Unusual radiographic presentation of pulmonary tuberculosis in diabetic patients. Am Rev Respir Dis 1974, 109; 162-6

45.  Ravindran, Joshi, Sundaram, Raj, Parameswaran- Lower Lung Field Tuberculosis, Ind.Jour. Tub. 39: 29- 31, 1992.

46.  Gupa S, Shenoy VP, Bairy I, Srinivasa H, Makhapadhyay C. Diabetes mellitus and HIV a co-morbidities in tuberculosis patients of rural south India. J Infect Public Health. 2011;4:140–4. [PubMed]

47.  Caspian J Intern Med. 2012 Spring; 3(2): 421–424.Pulmonary tuberculosis and diabetes mellitus: Co-existence of both diseases in patients admitted in a teaching hospital in the southwest of Iran Seyed Mohammad Alavi, MD1 and Mohammad Mehdi Khoshkhoy, MD2

Corresponding Author

Dr Rajani.M

Associate Professor, Department Of Respiratory Medicine, Pariyaram Medical College,

Pariyaram, Kannur, Kerala, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile Number-9447263597