Title: Clinical Response and Treatment Response in Sputum Positive Diabetic and Non-Diabetic Patients

Authors: Dr Padmanabhan.K.V, Dr Muhammad Shafeek, Dr Jesinkumar .C, Dr Jerin Varghese, Dr Shinil.V, Dr Manoj.D.K

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.18

Abstract

Tuberculosis is still a major public health problem in the world with an estimated 9.6 million new cases being diagnosed each year.. DM may delay sputum conversion and may increase the case fatality rate during treatment. Aim  of our study was to find out the clinical pattern, radiological pattern and response to treatment of pulmonary tuberculosis among patients with and without diabetes mellitus:

Materials and Methods: 150 diabetics and non-diabetics with sputum positive pulmonary tuberculosis were selected, as cases and controls respectively. Data regarding the socio-demographic profile, age, sex, clinical presentation and radiological pattern were collected. Sputum smear examination was done in all patient at diagnosis, end of IP and end of treatment. Treatment was considered to have failed if the patient is positive at the end of 5 months treatment.

Results: There was no significant difference in the symptomatology and symptom score between diabetics (2.77) and non-diabetics (2.14). A higher percentage of diabetics (18.8%) showed lower zone involvement when compared to non-diabetics (5.8%). 19.3% of the diabetics were sputum positive at the end of IP of which 4.4% were sputum positive at the end of 5 months and had to undergo a change in treatment regimen due to failure.

Conclusion: Tuberculosis and diabetes frequently coexist in our population. The presence of diabetes may not significantly influence the symptomatology of the patients. However, DM has a negative effect on TB treatment with a larger number of diabetics requiring a change in category of ATT.

Keywords: Pulmonary Tuberculosis, Diabetes Mellitus, Sputum Conversion.

References

  1. WHO Global Tuberculosis Report 2018
  2. International Diabetes Fedration 2018 Report
  3. Lönnroth K Roglic Harries AD Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice Lancet Diabetes Endocrinol2014; 2:730–9. 
  4. Hodgson K, Morris J, Bridson T, et al. Immunological mechanisms contributing to the double burden of diabetes and intracellular bacterial infections. Immunology2015; 144:171–85.
  5. Harries AD, Dye C. Tuberculosis. Ann Trop Med Parasitol. 2006;100(5-6):415-31.
  6. International Diabetes Federation. IDF diabetes atlas. 4th edition. Brussels, Belgium: International Diabetes Federation; 2009.
  7. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9 (12):737-468 Worldwide, 70% of diabetics live in TB endemic countries.
  8. Ramachandran A, Ma RCW, Snehalatha C. Diabetes in Asia. Lancet. 375;408-18.
  9. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. 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. 2011;378(9785):31-40.
  10. International Diabetes Federation. IDF Diabetes Atlas. 5th ed. International Diabetes Federation, Brussels. 2011. Available at http://www. eatlas.idf.org. Accessed 20 July 2011
  11. Cheng J, Zhang H, Zhao YL, et al. Mutual impact of diabetes mellitus and tuberculosis in China. Biomed Environ Sci2017; 30:384–9.
  12. Chiang CY, Bai KJ, Lin HH, et al. The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis. PLoS One 2015; 10:e0121698.
  13. Morsy AM,  Zaher HH, Hassan MH, Shouman A. Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt East Mediterr Health J 2003; 9:689–701.
  14. Jiménez-Corona ME, Cruz-Hervert LP, García-García L, et al. Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax2013; 68:214–20. 
  15. Singla R, Osman MM, Khan N, et al. Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatmentInt J Tuberc Lung Dis2003; 7:58–64. 
  16. Singla R, Khan NAl- Sharifn N, et al. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis2006; 10:74–9 
  17. Mahishale V, Avuthu S, PatilB, et al. Effect of poor glycemic control in newly diagnosed patients with smear-positive pulmonary tuberculosis and type-2 diabetes mellitus Iran J Med Sci2017; 42:144–51
  18. Pérez-Guzman C, Torres-Cruz A Villarreal- Velarde H, et al. Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study. Int J Tuberc Lung Dis2001; 5:455–61. 
  19. Marais RM. Diabetes mellitus in black and coloured tuberculosis patients  S Afr Med J1980; 57:483–4. 
  20. Jain NK Madan A, Sharma TN, et al. Diabetic tuberculosis: a changing pattern. Lung India1985; 3:11–4.
  21. Chiang CY Lee JJ, Chien ST, et al. Glycemic control and radiographic manifestations of tuberculosis in diabetic patients. PLoS One2014; 9:e93397.
  22. Huang LK, Wang HH, LaiYC, Chang SC. The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients. PLoS One2017; 12:e0179750.
  23. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. ClinInf Dis. 2007;45(4):428-35.
  24. Singla R, Khan N, Al-Sharif MO, Al-Sayegh MA. Shaikh MM, Osman. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis. 2006;10(1):74-9.
  25. Baby Nagapriya Vellalacheruvu* , Dr. Ragini Bekur**, Dr. Harika Mapakshi** Effect of type 2 Diabetes mellitus on Presentation and Treatment response of Sputum positive Pulmonary Tuberculosis. International Journal of Scientific and Research Publications, Volume 5, Issue 9, September 2015 1 ISSN 2250-3153 www.ijsrp.org
  26. Restrepo BI, Fisher-Hoch SP, Crespo JG, Whitney E, Perez A, Smith B, et al. Type 2 diabetes and tuberculosis in a dynamic bi-national border population. Epidemiol Infect. 2007;135(3):483-91. [
  27. Shaikh MA, Singla R, Khan NB, Sharif NS, Saigh MO. Does diabetes alter the radiological presentation of pulmonary tuberculosis. Saudi Med J. 2003;24(3):278-81.

Corresponding Author

Dr Muhammad Shafeek

MD Respiratory Medicine, Assistant Professor, Department of Respiratory Medicine, Pariyaram Medical College

Phone: 9995870650, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.