Title: Diabetes and Tuberculosis: The Study of Clinical-radiological Profile in Tertiary Care Hospital

Authors: Rawal Divyant, Gupta Virendra, Varshney Amit

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i2.67

Abstract

Background - DM is a well known risk factor for TB in the past 1,2. Patient with diabetes mellitus type-2 are in particular more prone to getting into infections, including TB, which are more difficult to treat because of their inherent weak immune system, the high prevalence of diabetes could adversely affect global TB control effort 3,4. Historically, the incidence of tuberculosis in patients with diabetes has been high, 5, 6,7. The incidence of TB showing it to be two to five time higher in diabetic patients Than in non-diabetic patients 8,9-11. TB in diabetic patients has been reported to have more cavitatry lesion, less sputum positivity and paucity of symptoms and signs compared to TB in non-diabetic patients 10.

Method - The study was carried out on patients attending the OPD/IPD of department of General Medicine, SRMS-IMS, Bareilly, U.P. between Jan’2013 to Jan-2015. After a detailed history and thorough examinations all patient were subjected to sputum smear for AFB examination, X-ray chest PA view and hematological investigation.

Result - A total 58 proven cases of pulmonary tuberculosis, who were known diabetics were included in this study. Out of 58 cases, 34(58.6%) were male and 24(41.4%) were female. Male to female ratio was (1.4:1). The mean age of was 48.2 + 12.3 yrs. The majority of patients were between 41-60 years of age followed by 61-80 and 20-40 years i.e. 31,12,12 respectively. Out of 58 patients, 32 (55.2%) cases were sputum positive, rest of them were sputum negative. In 32 cases 19 cases were male and 13 cases were female.

Conclusion - DM is a known risk factor for TB in endemic area, and this risk increases with age. In general, TB is a disease that should be considered in diabetic patients with an atypical clinical and radiological presentation.

Keywords: Diabetes Mellitus, Pulmonary Tuberculosis, Sputum Positive.

References

1.      Boucot KR, Dillon ES, Cooper DA. Tube-rculosis among diabetics: Philadelphia survey. Am Rev Tuberc 1952; 65: 1-50.

2.      Root HF. The association of diabetes and tuberculosis. N Eng J Med 1934; 210: 1-13.

3.      B. Alisjahbana, R. van Crevel, E. Sahiratmadja, M. den Heijer, A. Maya, et al, Diabetes mellitus is strongly associated with tuberculosis in Indonesia, Int. J. Tuberc. Lung Dis. 10 (2006) 696–700.

4.      A. Perez, H.S. Brown 3rd, B.I. Restrepo, Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas, Am. J. Trop. Med. Hyg. 74 (2006) 604–61.

5.      Sarah Lou Bailey and Paul Grant. The tubercular diabetic : the impact of diabetes mellitus on tuberculosis and its threat to global tuberculosis control. 2011;11(4) : 344-7.

6.      Barach J. Historical facts in diabetes mellitus. Ann Med Hist 1928;10:387.

7.      Root H. The association of diabetes and tuberculosis. N Engl J Med 1934;210:1, 78,127.

8.      Lancet Infect Dis. Tuberculosis and diabetes mellitus: convergence of two epidemics. 2009 December;9(12);737-746.

9.      Banerjee S, Banerjee M. Diabetes and tuberculosis interface. J Indian Med Assoc 2005;103:318,320,322 passim.

10.  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;120:1514–9.

11.  Jeon CY,Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5:e152.

12.  Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg 2009;80:634–9.

13.  Sentochnik DE, Eliopoulos GM. Infection and diabetes. In : Kahn CR, Weir GC, editors. Joslin’s diabetes mellitus. 13th edition. Vol. 1. New Delhi: BI Waverly Pvt. Ltd; 1996.p.868-873, 881-882.

14.  Hoddinott S, Dornan J, Bear JC, Farid NR. Immunoglobulin levels, immunodeficiency and HLA in type 1 diabetes mellitus. Diabetologia1 982;23 :326-29.

15.  Feza B, Ozen KB, Gursel C, Abdullah S, Mahmut A. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 2001 ;68:595-600.

Corresponding Author

Dr Amit Varshney

Assistant Professor Department of Medicine, SRMS IMS Bareilly Pin-243001

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.