Abstract
Diabetes mellitus is an independent risk factor for lower respiratory tract infections. Patients with diabetes are at greater risk of contracting tuberculosis, and diabetes can worsen the course of tuberculosis. Hyperglycemia appears to be a contributory factor to the development of pulmonary tuberculosis in diabetic patients. Complications related to uncontrolled blood sugar level are high in patients with tuberculosis. Also tuberculosis affects the effective control of blood sugar in diabetic patients requiring increase need of OHA and insulin. So both diseases have add on effect on others, pathogenicity control and management.
Results: Total 150 cases of diabetes mellitus taken.Maximum patients belong’s to age group >60 yrs in non-tuberculosis & 51-60 years in tuberculosis group; Male are More affected than Female. Most Common symptom was chest pain (29.62%) in patients of diabetes without tuberculosis may be due to older age group whereas anorexia (100%) was most common symptom in patients of tuberculosis with diabetes. When we compare clinical profile of diabetic patients it was found thatpulse rate is high , systolic and diastolic blood pressure was found to be significantly lower, mean PPBS (290.24 mg%) higher, total cholesterol lower, weight & BMI significantly lower in tubercular group. In clinical profile of diabetes with tuberculosis patients among all the studied parameters total cholesterol, LDLc and weight was found to be significantly lower in pulmonary as compared with extra pulmonary tuberculosis. Complications like retinopathy, neuropathy, nephropathy and other macrovascular complications are more in tubercular group but difference in retinopathy statistically significant .Chest radiograph revealed that 11.76% of patients had unilateral & 70.58% had bilateral lesions in which predominant lesion in middle & lower zone i.e 41.17% .Cavity noted in 17.60%.
Keywords: OHA: Oral hypoglycaemic agents, HIV: Human immunodeficiency virus, CSF: Cerebrospinal fluid, PPBS: Post prandial blood sugar, LDLc: Low density lipoprotein’s.
References
1. SoundararajanRaghuraman, Kavita P Vasudevan, S Govindarajan,1PalanivelChinnakali, and Krishna Chandra Panigrahi Prevalence of Diabetes Mellitus among Tuberculosis Patients in Urban Puducherry.. (N Am j med sci 2014 jan 6 ; 30-4. doi:10.4103/1947-2714.125863)
2.Study on prevalence of diabetes mellitus in tuberculosis [Indian J Tuberc. 2014] -PubMed – NCBI & http://www.who.int/bulletin/volumes/89/5/10-085738/en]
3. Dr. Murugnathan ,DR. Vijay vishwanathan Double Burden of Tuberculosis and Diabetes in India section 5 API : Chapter 32 The by Dr. Murugnathan ,DR. Vijay vishwanathan.
4. Gonzalen et. al High glucose concentration induced TNF- alfa production through the down regulation of CD-33in primary human monocytes. By BMC immunology 2012 13:19
5. Singla R, Khan N, Al-Sharif N, Al-Sayegh O, Shaikh M, Osman M. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis 2006; 10: 74-9.
6. Deshmukh PA, Shaw T. Pulmonary tuberculosis and diabetes mellitus. Ind J Tub 1984;31:114
7. Feleke Y, Abdulkadir J, Aderaye G. Prevalence and clinical features of tuberculosis in Ethiopian diabetic patients. East Afr Med J 1999;76(7):361-64.
8. Thompson Campbell The Pulse Rate in Pulmonary Tuberculosis BY Med J. 1901 Jun 1; 1(2109): 1334–1335.
9. MugusiF ,Swai AB, Turner SJ, Alberti KG, McLarty DG. Trans R Soc Hypoadrenalism in patients with pulmonary tuberculosis in Tanzania: anundiagnosed Trop Med Hyg. 1990 Nov-Dec;84(6):84951.
10. Malhotra P. Prevalence of tuberculosis in kishtwar Tehsil of Jammu region. J Indian Med Assoc 1996;94:334-337.
11. Gordonleitch A., Anthony Seaton, Douglas Seaton, Gordonleitch A, editors. Crofton and Douglas’s respiratory diseases. 5th edition. 2 vol: vol 1. Oxford: Blackwell Science; 2000.p.515-521.
12. Sachdeva AK, Arora RC, Misra DN. Clinicoradiological study of pulmonary tuberculosis in diabetics. J Assoc Physicians India 1984;32:30.
13. Oluboyo PO, Erasmus RT. The significance of glucose intolerance in pulmonary tuberculosis. Tubercle 1990;71(2):135-38.
14. Yung-Hsiang Lin, Chia-Pei Chen, Pao-Ying Chen, Jui-Chu Huang, Cheng Ho, Hsu-HueiWeng, Ying-Huang Tsai and Yun-Shing Peng. Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital( TAIWAN). (BMC public health. 2015 jan 8; 15:3.doi 10.1186/1471-2458-15-3.)
15. Diabetic Nephropathy: Diagnosis, Prevention, and Treatment. Diabetes Carecare.diabetesjournals.ORG DOI: 10.2337/diacare.28.1.164 Diabetes Care January 2005 vol. 28 no. 1 164-176
16. SoundararajanRaghuraman, Kavita P Vasudevan, S Govindarajan,1PalanivelChinnakali, and Krishna Chandra Panigrahi Prevalence of Diabetes Mellitus among Tuberculosis Patients in Urban Puducherry.. (N Am j med sci 2014 jan 6 ; 30-4. doi:10.4103/1947-2714.125863)
17. Neeti Gupta, Rohit Gupta Diabetic Retinopathy–An Update
Department of Ophthalmology and Medicine,
Himalayan Institute of Medical Science , Dehradun, Uttarakhand, India JIMSA Jan. - Mar. 2015 Vol. 28 No. 1
18. Pérez-Guzmán C, Vargas M, Torres-Cruz A, Pérez-Padilla J, Furuya M, Villarreal-Velarde H. Diabetes modifies the male : female ratio in pulmonary tuberculosis. Int J Tuberc Lung Dis 2003; 7: 354-8.
19. Dr. NavneetWadhwa, MD (Pharmacology), Tuberculosis and Diabetes - The Converging Epidemic Mumbai, India.(Journal of Clinical and Preventive Cardiology, January 2015 ).
20. www.who.int./tb/publications/sept 2011.
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.50
