DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175454

Presentation of pulmonary tuberculosis in diabetics and response to anti-tuberculosis therapy

Md Abdul Waseem, Misba Zahera, V. Gopalakrishnaiah

Abstract


Background: Diabetes and Tuberculosis are known to be mutually affective. In high tuberculosis and Diabetes burden country like ours, it is essential that we understand all the aspects concerning both these diseases individually and in mutual coexistence, in order to improve the management of this unhealthy partnership.

Methods: This is a prospective hospital based observational study, in which 100 patients with coexisting Diabetes and new sputum confirmed pulmonary tuberculosis with no other comorbidities were included. Detailed history, examination and appropriate investigations were done evaluating the clinical and radiological presentation and treatment response in terms of sputum conversion at follow up visits.

Results: Predominant symptoms were anorexia, fever and cough with sputum, majority with duration of more than 4 weeks. About half of them had diabetes duration of less than 1 year, most being newly diagnosed. All cases had upper lobe involvement; two thirds of them had lower lung field and multiple lobe involvement. Confluent consolidation, cavitary lesions and fluffy infiltrates were common. 27 of the 100 cases had a delayed sputum conversion. Longer duration of diabetes, maintenance on oral hypoglycaemic drugs alone and uncontrolled diabetes had delayed sputum conversion.

Conclusions: Presenting symptoms of tuberculosis in diabetics is more or less similar to that in non-diabetics. Atypical radiological presentation with lower lung field involvement and confluent consolidation mimicking pneumonia is common. Delay in sputum conversion is common in dual disease and is increased with increasing DM duration and poor glycemic control. Better results may be obtained with insulin therapy.


Keywords


Diabetes, DOTS, Glycated haemoglobin, Sputum conversion, Tuberculosis

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References


Global tuberculosis report, 2016. Available at: www.who.int/tb/data.

Global report on diabetes, 2017. Available at: http://www.who.int.

Tullt'k JA. Diabetes mellitus in the tropics. E and S Livingstone: London. 1962:131.

United Nations. Department of Economic. World Population Prospects: The 2004 Revision. Sex and age distribution of the world population. United Nations Publications; 2006.

Valerius NH, Eff C, Hansen NE, Karle H, Nerup J, Søeberg B, Sørensen SF. Neutrophil and lymphocyte function in patients with diabetes mellitus. J Inter Medic. 1982;211(6):463-7.

Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1997;14:29-34.

Deshmukh PA and Shaw T. Pulmonary tuberculosis and diabetes mellitus. Ind J Tuber. 1984;31:114-7.

Tripathy SR, Kar KP, Chakraborty DC, Mazumdar AK. Diabetes mellitus and pulmonary tuberculosis-a prospective study. Ind J Tuber. 1984;31:122-5.

Patel JC, De Souza, Cheryl and Jigjini SS. Diabetes and Tuberculosis. Ind J Tuber. 1977;24:155-58. Dunham K, Norton W: Basal tuberculosis. JAMA 1927;89:1573-5.

Bacakoglu F, Basoglu O O, Cok G, Sayiner A, Atres M. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration. 2000;68:595-600.

Ossen EZ. Tuberculosis of the lower lobe. New Eng J Medic. 1944;230(23):693-8.

Dunham K, Norton VV. Basal tuberculosis. J Ame Medic Assoc. 1927;89(19):1573-5.

Babu RV, Manju R, Kumar SV, Das AK. Occurrence of Diabetes mellitusin Pulmonary Tuberculosis Patients. Worl J Medic Sci. 2013;8(4):345-8.

Mugusi F, Swai AB, Alberti KG, McLarty DG. Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania. Tubercle. 1990;71(4):271-6.

Jeon CY, Harries AD, Baker MA, Hart JE, Kapur A, Lönnroth K, Ottmani SE, Goonesekera S, Murray MB. Bi‐directional screening for tuberculosis and diabetes: a systematic review. Tropic Medic Inter Heal. 2010;15(11):1300-14.

Khan A. Social enterprise models for lung health and diabetes screening and management in three Asian megacities, 2014. Available at https://www. captb.org/sites/default/files/documents/Social%20Enterprise%20-%20Aamir_Khan.pdf. Accessed 12 July 2016.

Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, Law WS, Tam CM, Chan CK, Chang KC. Diabetic control and risk of tuberculosis: a cohort study. Americ J Epidemiol. 2008;167(12):1486-94.

Sen T, Joshi SR, Udwadia ZF. Tuberculosis and diabetes mellitus: merging epidemics. J Assoc Physicians India. 2009;57(1):399-404.

Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Salazar-Lezama M, Vargas M. Atypical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study. Inter J Tuber Lung Dis. 2001;5(5):455-61.

Sosman MC, Steidl JH. Diabetic tuberculosis. A J R 1927;17:625.

Baghaei P, Tabarsi P, Abrishami Z, Mirsaeidi M, Faghani YA, Mansouri SD, et al. Comparison of pulmonary TB patients with and without diabetes mellitus type II. Tanaffos. 2010;9(2):13-20.

Guler M, Unsal E, Dursun B, AydIn O, Capan N. Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Inter J Clin Pract. 2007;61:231-35.

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 Tuber Lung Dis. 2006;10(1):74-79.

Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC medicine. 2011;9(1):81.

Oluboyo PO, Erasmus RT. The significance of glucose intolerance in pulmonary tuberculosis. Tubercle. 1990;71(2):135-8.

Basoglu OK, Bacakoglu F, Cok G, Saymer A, Ates M. The oral glucose tolerance test in patients with respiratory infections. Monaldi Archives for Chest Disease. 1999;54:307-10.

Park SW, Shin JW, Kim JY, Park IW, Choi BW, Choi JC, et al. The effect of diabetic control status on the clinical features of pulmonary tuberculosis. Euro J clinic Microbiol Infectious Dis. 2012;31(7):1305-10.