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Yang J, Kim SH, Sim JK, Gu S, Seok JW, Bae DH, Cho JY, Lee KM, Choe KH, Lee H, Yang B, Min KH. Tuberculosis survivors and the risk of cardiovascular disease: analysis using a nationwide survey in Korea. Front Cardiovasc Med 2024; 11:1364337. [PMID: 39185138 PMCID: PMC11341360 DOI: 10.3389/fcvm.2024.1364337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024] Open
Abstract
Background Although the association between tuberculosis (TB) and cardiovascular disease (CVD) has been reported in several studies and is explained by mechanisms related to chronic inflammation, few studies have comprehensively evaluated the association between TB and CVD in Korea. Methods Using the Korea National Health and Nutrition Survey, we classified individuals according to the presence or absence of previous pulmonary TB was defined as the formal reading of a chest radiograph or a previous diagnosis of pulmonary TB by a physician. Using multivariable logistic regression analyses, we evaluated the association between the 10-year atherosclerotic cardiovascular disorder (ASCVD) risk and TB exposure, as well as the 10-year ASCVD risk according to epidemiological characteristics. Results Among the 69,331 participants, 4% (n = 3,101) had post-TB survivor group. Comparing the 10-year ASCVD risk between the post-TB survivor and control groups, the post-TB survivor group had an increased 10-year ASCVD risk in the high-risk group (40.46% vs. 24.00%, P < 0.001). Compared to the control group, the intermediate- and high-risk groups had also significantly increased 10-year ASCVD risks (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.23 and OR 1.69, 95% CI 1.59-1.78, respectively) in the post-TB survivor group. In the association of CVD among post-TB survivors according to epidemiologic characteristics, age [adjusted OR (aOR) 1.10, 95% CI 1.07-1.12], current smoking (aOR 2.63, 95% CI 1.34-5.14), a high family income (aOR 2.48, 95% CI 1.33-4.62), diabetes mellitus (aOR 1.97, 95% CI 1.23-3.14), and depression (aOR 2.06, 95% CI 1.03-4.10) were associated with CVD in the post-TB survivor group. Conclusions Our study findings suggest a higher 10-year ASCVD risk among TB survivors than healthy participants. This warrants long-term cardiovascular monitoring and management of the post-TB population.
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Affiliation(s)
- Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sun-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae Kyeom Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, Republic of Korea
| | - Jeong Won Seok
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Dae-Hwan Bae
- Department of Cardiology, Chungbuk National University College of Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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2
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Yanqiu X, Yang Y, Xiaoqing W, Zhixuan L, Kuan Z, Xin G, Bo Z, Jinyu W, Jing C, Yan M, Aiguo M. Impact of hyperglycemia on tuberculosis treatment outcomes: a cohort study. Sci Rep 2024; 14:13586. [PMID: 38866898 PMCID: PMC11169383 DOI: 10.1038/s41598-024-64525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/10/2024] [Indexed: 06/14/2024] Open
Abstract
Hyperglycemia is prevalent and closely associated with pulmonary tuberculosis (PTB). This study aimed to investigate the effects of hyperglycemia on the outcomes of PTB treatment. This study comprised 791 patients with PTB in total. Patients with fasting plasma glucose levels of ≥ 6.1 mmol/L were diagnosed with hyperglycemia. Anthropometric and baseline demographic data were also collected. The treatment response was assessed based on clinical symptoms (sputum production, cough, chest pain, fever, hemoptysis, night sweats, loss of appetite, and fatigue), sputum smear, chest computed tomography (CT), and adverse gastrointestinal responses (vomiting, nausea, abdominal distension, diarrhea, and constipation). A generalized estimating equation (GEE) was used to evaluate these relationships. Hyperglycemia affected 266 (33.6%) of the 791 patients with PTB. In GEE analyses, patients with hyperglycemia exhibited a greater incidence of elevated tuberculosis (TB) scores (odds ratio (OR) 1.569; 95% CI 1.040-2.369), cough (OR 1.332; 95% CI 1.050-1.690), and night sweats (OR 1.694; 95% CI 1.288-2.335). Hyperglycemia was linked with a higher risk of positive sputum smears (OR 1.941; 95% CI 1.382-2.727). During therapy, hyperglycemia was also associated with an increased incidence of vomiting (OR 2.738; 95% CI 1.041-7.198), abdominal distension (OR 2.230; 95% CI 1.193-4.171), and constipation (OR 2.372; 95% CI 1.442-3.902). However, the CT results indicated that hyperglycemia did not affect pulmonary lesions in patients with TB. Patients with TB and hyperglycemia are at a higher risk of severe clinical manifestations, positive sputum smears, and adverse gastrointestinal effects and, therefore, the special situation of hyperglycemic patients should be considered in the prevention and treatment of TB.
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Affiliation(s)
- Xu Yanqiu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Yang Yang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China.
| | - Wu Xiaoqing
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Lei Zhixuan
- Yuncheng Center for Disease Control and Prevention, Yuncheng, Shanxi, China
| | - Zhao Kuan
- Qingdao No.6 People's Hospital, Qingdao, Shandong, China
| | - Guo Xin
- Department of Infection and Disease Control, Sunshine Union Hospital, Weifang, Shandong, China
| | - Zhang Bo
- Weifang No.2 People's Hospital, Weifang, Shandong, China
| | - Wang Jinyu
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Cai Jing
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Ma Yan
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
| | - Ma Aiguo
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao, Shandong, China
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3
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Bermúdez-Hernández GA, Pérez-Martínez D, Ortiz-León MC, Muñiz-Salazar R, Licona-Cassani C, Zenteno-Cuevas R. Mutational Dynamics Related to Antibiotic Resistance in M. tuberculosis Isolates from Serial Samples of Patients with Tuberculosis and Type 2 Diabetes Mellitus. Microorganisms 2024; 12:324. [PMID: 38399727 PMCID: PMC10892438 DOI: 10.3390/microorganisms12020324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
Genetic variation in tuberculosis is influenced by the host environment, patients with comorbidity, and tuberculosis-type 2 diabetes mellitus (TB-T2DM) and implies a higher risk of treatment failure and development of drug resistance. Considering the above, this study aimed to evaluate the influence of T2DM on the dynamic of polymorphisms related to antibiotic resistance in TB. Fifty individuals with TB-T2DM and TB were initially characterized, and serial isolates of 29 of these individuals were recovered on day 0 (diagnosis), 30, and 60. Genomes were sequenced, variants related to phylogeny and drug resistance analyzed, and mutation rates calculated and compared between groups. Lineage X was predominant. At day 0 (collection), almost all isolates from the TB group were sensitive, apart from four isolates from the TB-T2DM group showing the mutation katG S315T, from which one isolate had the mutations rpoB S450L, gyrA A90G, and gyrA D94G. This pattern was observed in a second isolate at day 30. The results provide a first overview of the dynamics of mutations in resistance genes from individuals with TB-T2DM, describing an early development of resistance to isoniazid and a rapid evolution of resistance to other drugs. Although preliminary, these results help to explain the increased risk of drug resistance in individuals with TB and T2DM.
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Affiliation(s)
- Gustavo A. Bermúdez-Hernández
- Biomedical Sciences Doctoral Program, Institute of Health Sciences, University of Veracruz, Xalapa 91190, Veracruz, Mexico;
| | - Damián Pérez-Martínez
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
| | - Maria Cristina Ortiz-León
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
| | - Raquel Muñiz-Salazar
- School of Health Sciences, Autonomous University of Baja California, Ensenada 22860, Baja California, Mexico;
| | - Cuauhtemoc Licona-Cassani
- Monterrey Institute of Technology, School of Engineering and Sciences, Monterrey 64700, Nuevo León, Mexico;
| | - Roberto Zenteno-Cuevas
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
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Zhao L, Fan K, Sun X, Li W, Qin F, Shi L, Gao F, Zheng C. Host-directed therapy against mycobacterium tuberculosis infections with diabetes mellitus. Front Immunol 2024; 14:1305325. [PMID: 38259491 PMCID: PMC10800548 DOI: 10.3389/fimmu.2023.1305325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Tuberculosis (TB) is caused by the bacterial pathogen Mycobacterium tuberculosis (MTB) and is one of the principal reasons for mortality and morbidity worldwide. Currently, recommended anti-tuberculosis drugs include isoniazid, rifampicin, ethambutol, and pyrazinamide. TB treatment is lengthy and inflicted with severe side-effects, including reduced patient compliance with treatment and promotion of drug-resistant strains. TB is also prone to other concomitant diseases such as diabetes and HIV. These drug-resistant and complex co-morbid characteristics increase the complexity of treating MTB. Host-directed therapy (HDT), which effectively eliminates MTB and minimizes inflammatory tissue damage, primarily by targeting the immune system, is currently an attractive complementary approach. The drugs used for HDT are repositioned drugs in actual clinical practice with relative safety and efficacy assurance. HDT is a potentially effective therapeutic intervention for the treatment of MTB and diabetic MTB, and can compensate for the shortcomings of current TB therapies, including the reduction of drug resistance and modulation of immune response. Here, we summarize the state-of-the-art roles and mechanisms of HDT in immune modulation and treatment of MTB, with a special focus on the role of HDT in diabetic MTB, to emphasize the potential of HDT in controlling MTB infection.
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Affiliation(s)
- Li Zhao
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Ke Fan
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Xuezhi Sun
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Wei Li
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Fenfen Qin
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Liwen Shi
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Feng Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunlan Zheng
- Department of Tuberculosis III, Wuhan Pulmonary Hospital, Wuhan, Hubei, China
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5
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Prakoso DA, Istiono W, Mahendradhata Y, Arini M. Acceptability and feasibility of tuberculosis-diabetes mellitus screening implementation in private primary care clinics in Yogyakarta, Indonesia: a qualitative study. BMC Public Health 2023; 23:1908. [PMID: 37789310 PMCID: PMC10546762 DOI: 10.1186/s12889-023-16840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The relationship between Tuberculosis (TB) and Diabetes Mellitus (DM) is intricate and intertwined, posing significant global health challenges. In addition, the increasing prevalence of DM worldwide raises concerns regarding the potential resurgence of tuberculosis. The implementation of tuberculosis prevention strategies is of the utmost importance, especially in countries like Indonesia that encounter a dual burden of TB and DM. The significance of TB screening in private primary care settings for patients with diabetes cannot be overstated. Implementing TB screening protocols in private primary care settings can assist in identifying diabetic patients with tuberculosis. Therefore, this study aims to explore the acceptability and feasibility of tuberculosis-diabetes mellitus screening implementation in private primary care clinics. METHODS We conducted implementation research with an exploratory qualitative design. Fifteen healthcare professionals from five private primary health care clinics in Yogyakarta, Indonesia, participated in five focus groups. The discussions were audio recorded, transcribed verbatim, and thematically analyzed. As part of the feasibility assessment, surveys were conducted in each clinic. We conducted a thematic analysis in accordance with the theoretical framework of acceptability and the feasibility assessment. RESULTS We identified that most private primary care clinics deemed the implementation of TB screening in DM patients acceptable and practicable. We revealed that the majority of diabetes patients enthusiastically accepted TB-DM screening services. In addition, we found that the healthcare professionals at the clinic are aware of the nature of the intervention and demonstrates a positive attitude despite a subtle burden. The stigma associated with COVID-19 has emerged as a new implementation barrier, joining TB stigma, lack of resources, and regulatory issues. We identify concealed and tiered screening as a potential method for enhancing the implementation of TB-DM screening. CONCLUSIONS The implementation of TB screening in DM patients in private primary care clinics had the potential to be acceptable and feasible. To achieve a successful implementation, consideration should be given to supporting factors, hindering factors, and strategies to improve TB screening in DM patients.
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Affiliation(s)
- Denny Anggoro Prakoso
- Doctoral Program of Medical and Health Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Wahyudi Istiono
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yodi Mahendradhata
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Merita Arini
- Master of Hospital Administration, Postgraduate Program, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
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6
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Rendón Ramírez EJ, Rosas-Taraco AG, Soto-Monciváis B, Colunga-Pedraza PR, Salazar-Riojas R, Méndez-Ramírez N, Arce-Mendoza AY, Muñiz-Buenrostro A, Llaca-Díaz J, Gomez-Almaguer D, Rendón A. Comparison of CD4+/CD8+ Lymphocytic Subpopulations Pre- and Post-Antituberculosis Treatment in Patients with Diabetes and Tuberculosis. Pathogens 2023; 12:1181. [PMID: 37764989 PMCID: PMC10536186 DOI: 10.3390/pathogens12091181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Is there a CD4+ and CD8+ immunity alteration in patients with pulmonary tuberculosis (TB) and diabetes (DM) that does not recover after antituberculosis treatment? This prospective comparative study evaluated CD4+ and CD8+ lymphocytic subpopulations and antituberculosis antibodies in patients with diabetes and tuberculosis (TB-DM), before and after antituberculosis treatment. CD4+ T cell counts were lower in patients with TB-DM compared to those with only TB or only DM, and these levels remained low even after two months of anti-TB treatment. Regarding the CD8+ T cell analysis, we identified higher blood values in the DM-only group, which may be explained by the high prevalence of latent tuberculosis (LTBI) in patients with DM. IgM antituberculosis antibodies levels were elevated in patients with only TB at baseline, and 2 months post-anti-TB treatment, IgG did not express any relevant alterations. Our results suggest an alteration in CD4+ immunity in patients with TB-DM that did not normalize after antituberculosis treatment.
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Affiliation(s)
- Erick J. Rendón Ramírez
- Servicio de Neumología y Medicina Crítica, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Adrián G. Rosas-Taraco
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Berenice Soto-Monciváis
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Perla R. Colunga-Pedraza
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Rosario Salazar-Riojas
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Nereida Méndez-Ramírez
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Alma Yolanda Arce-Mendoza
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Antonio Muñiz-Buenrostro
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Jorge Llaca-Díaz
- Departamento de Patología Clínica, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - David Gomez-Almaguer
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Adrián Rendón
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
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7
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Ortiz-Hernández A, Castro Flores JA, Álvarez-Hernández DA, Pérez Aldrett F, Herrera González LP, Méndez Ibarra JU. Acute cholecystitis complicated with gallbladder empyema due to Mycobacterium tuberculosis in a patient with diabetes mellitus: a case report. Ther Adv Infect Dis 2022; 9:20499361221129161. [PMID: 36248186 PMCID: PMC9558873 DOI: 10.1177/20499361221129161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Acute cholecystitis severity ranges from mild to very severe, and its most dreadful complication is gallbladder empyema. It can be caused by several etiologic agents, but Mycobacterium tuberculosis is not common among them. Here we present a 61-year-old female who lives in an area of high tuberculosis endemicity and has type 2 diabetes mellitus. She came to our hospital with a 2-day history of moderate-to-severe colicky right upper quadrant abdominal pain and other clinical manifestations compatible with AC. Imaging studies confirmed the diagnosis. An emergency open cholecystectomy was performed and the gallbladder was sent for histopathologic examination. M. tuberculosis was identified by molecular studies and the treatment was adjusted. The patient recovered uneventfully. The clinical history and physical examination are essential for raising the index of suspicion, but complementary evaluation with imaging studies is necessary to confirm the diagnosis and evaluate its complications. Tuberculosis is a major health problem worldwide, and health professionals should be aware of its clinical spectrum to approach and manage common and uncommon presentations within their scope of attention.
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Affiliation(s)
| | - Jorge Andrés Castro Flores
- Faculty of Medicine, Autonomous University of
San Luis Potosí, San Luis Potosí, México,Hospital General ISSSTE, San Luis Potosí,
México
| | - Diego-Abelardo Álvarez-Hernández
- Faculty of Health Sciences, Anáhuac University
México, Huixquilucan, México,Faculty of Infectious and Tropical Diseases,
London School of Hygiene & Tropical Medicine, London, UK
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8
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Yu Y, Liu Y, Yao L, Shen Y, Sun Q, Sha W. Factors Influencing False-Negative Results of QuantiFERON-TB Gold In-Tube (QFT-GIT) in Active Tuberculosis and the Desirability of Resetting Cutoffs for Different Populations: A Retrospective Study. Trop Med Infect Dis 2022; 7:tropicalmed7100278. [PMID: 36288019 PMCID: PMC9607193 DOI: 10.3390/tropicalmed7100278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives The value of QuantiFERON-TB Gold In-Tube (QFT-GIT) in the diagnosis of TB varies by population, comorbidities, and other factors. In this study, we aimed to investigate factors that influence false-negative results of QFT-GIT test in the diagnosis of TB as well as the impact of different cutoffs on the diagnostic value. Methods A total of 3562 patients who underwent QFT-GIT tests at Shanghai Pulmonary Hospital were enrolled retrospectively between May 2016 and May 2017. False-negative and false-positive results were analyzed using different clinical stratifications. The optimal cutoff values were established under different clinical conditions. Results Positive QFT-GIT results greatly shortened the time taken to diagnose smear-negative TB. The factors of age, smear and culture results, site of TB, comorbidity with tumors, white blood cell count, neutrophil count, and CD4/CD8 ratio were significantly correlated with false-negative QFT-GIT results (p < 0.05). Personalized cutoff values were established according to different influencing factors. The results showed high consistency between the smear-negative and total populations. Conclusion QFT-GIT can facilitate the early diagnosis of smear-negative TB. The diagnostic performance of the QFT-GIT test in the diagnosis of active TB was shown to be affected by many clinical factors. Personalized cutoff values may have superior value in the identification of active tuberculosis under different conditions.
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Affiliation(s)
- Yuanyuan Yu
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Yidian Liu
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Lan Yao
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Yanheng Shen
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
| | - Qin Sun
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Correspondence: (Q.S.); (W.S.)
| | - Wei Sha
- Department of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Clinical and Research Center for Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai 200433, China
- Correspondence: (Q.S.); (W.S.)
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9
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Piccolo G, De Rose EL, Bassi M, Napoli F, Minuto N, Maghnie M, Patti G, d’Annunzio G. Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2022; 13:966344. [PMID: 36093078 PMCID: PMC9449538 DOI: 10.3389/fendo.2022.966344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.
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Affiliation(s)
- Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neuro-oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Lucia De Rose
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Flavia Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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10
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Impact of diabetes mellitus on rifampicin's plasma concentration and bioavailability in patients with tuberculosis: A systematic review and meta-analysis study. Therapie 2022; 78:313-324. [DOI: 10.1016/j.therap.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/27/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
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Wei R, Li P, Xue Y, Liu Y, Gong W, Zhao W. Impact of Diabetes Mellitus on the Immunity of Tuberculosis Patients: A Retrospective, Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:611-627. [PMID: 35431587 PMCID: PMC9005360 DOI: 10.2147/rmhp.s354377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/26/2022] [Indexed: 12/27/2022] Open
Abstract
Background Tuberculosis (TB) is an infectious disease that poses a significant health threat and is one of the leading causes of death worldwide. Diabetes mellitus (DM) has high morbidity and mortality rates. Previous studies have reported that comorbidities can influence one another and aggravate immune disorders. A systematic and comprehensive evaluation of the immune status of patients with TB and DM (TB-DM) is helpful for early clinical immune intervention and for promoting the recovery of patients with TB-DM. Methods This study included 159 patients with TB without DM (TB-NDM) and 168 patients with TB-DM. Interferon-γ (IFN-γ) release assays (IGRAs) and TB-specific antibodies against 38kD+16kD proteins were used to detect humoral and cellular immune responses. Flow cytometry was used to analyze the absolute counts of the lymphocyte subsets. Results There was no significant difference in the positive rate of enzyme-linked immunospot (ELISPOT) assays, enzyme linked immunosorbent assay (ELISA), and 38kD+16kD antibodies between the TB-DM and TB-NDM groups. Pulmonary lobe lesion and cavity formation rates were significantly higher in patients with TB-DM with poor glycemic control than patients with TB-NDM and TB-DM with normal glycemic control. The absolute counts of T lymphocytes, CD8+ T lymphocytes, and B lymphocytes in patients with TB-DM were markedly lower than those in patients with TB-NDM. The absolute counts of T lymphocytes and CD8+ T lymphocytes in patients with TB-DM and hyperglycemia were lower than those in patients with euglycemia. Linear regression analysis revealed that the absolute counts of total T lymphocytes, CD8+ T lymphocytes, and NK cells in patients with TB-DM significantly decreased with increasing fasting blood glucose (FBG) levels. Conclusion Hyperglycemia is a risk factor for pulmonary cavity formation and lobe lesions in patients with TB-DM and suppresses the absolute counts of total T lymphocytes, CD8+ T lymphocytes, and NK cells in patients with TB-DM. The potential mechanism may involve the downregulation of innate and adaptive immune responses.
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Affiliation(s)
- Ruda Wei
- Senior Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
- Hebei North University, Zhangjiakou, 075000, Hebei, People’s Republic of China
| | - Pengchuan Li
- Hebei North University, Zhangjiakou, 075000, Hebei, People’s Republic of China
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
| | - Yong Xue
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
| | - Yinping Liu
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
| | - Wenping Gong
- Army Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, the Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
| | - Weiguo Zhao
- Senior Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, 100091, People’s Republic of China
- Hebei North University, Zhangjiakou, 075000, Hebei, People’s Republic of China
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Host Metabolic Changes during Mycobacterium Tuberculosis Infection Cause Insulin Resistance in Adult Mice. J Clin Med 2022; 11:jcm11061646. [PMID: 35329973 PMCID: PMC8948975 DOI: 10.3390/jcm11061646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) is a highly infectious bacterial disease that primarily attacks the lungs. TB is manifested either as latent TB infection (LTBI) or active TB disease, the latter posing a greater threat to life. The risk of developing active TB disease from LTBI is three times higher in individuals with type 2 diabetes mellitus (T2DM). The association between TB and T2DM is becoming more prominent as T2DM is rapidly increasing in settings where TB is endemic. T2DM is a chronic metabolic disorder characterized by elevated blood glucose, insulin resistance, and relative insulin deficiency. Insulin resistance and stress-induced hyperglycemia have been shown to be increased by TB and to return to normal upon treatment. Previously, we demonstrated that adipocytes (or fat tissue) regulate pulmonary pathology, inflammation, and Mycobacterium tuberculosis (Mtb) load in a murine model of TB. Metabolic disturbances of adipose tissue and/or adipocyte dysfunction contribute to the pathogenesis of T2DM. Thus, pathological adipocytes not only regulate pulmonary pathology, but also increase the risk for T2DM during TB infection. However, the cellular and molecular mechanisms driving the interaction between hyperglycemia, T2DM and TB remain poorly understood. Here, we report the impact of Mtb infection on the development of insulin resistance in mice fed on a regular diet (RD) versus high-fat diet (HFD) and, conversely, the effect of hyperglycemia on pulmonary pathogenesis in juvenile and adult mouse models. Overall, our study demonstrated that Mtb persists in adipose tissue and that Mtb infection induces irregular adipocyte lipolysis and loss of fat cells via different pathways in RD- and HFD-fed mice. In RD-fed mice, the levels of TNFα and HSL (hormone sensitive lipase) play an important role whereas in HFD-fed mice, ATGL (adipose triglyceride lipase) plays a major role in regulating adipocyte lipolysis and apoptosis during Mtb infection in adult mice. We also showed that Mtb infected adult mice that were fed an RD developed insulin resistance similar to infected adult mice that were overweight due to a HFD diet. Importantly, we found that a consequence of Mtb infection was increased lipid accumulation in the lungs, which altered cellular energy metabolism by inhibiting major energy signaling pathways such as insulin, AMPK and mToR. Thus, an altered balance between lipid metabolism and glucose metabolism in adipose tissue and other organs including the lungs may be an important component of the link between Mtb infection and subsequent metabolic syndrome.
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Herrera MT, Juárez E, Guzmán-Beltrán S, Torres M, Luna-Morales VA, Villalana-Alvarez LD, González Y. High Vitamin D Concentrations Restore the Ability to Express LL37 by M. tuberculosis-Infected Human Macrophages. Biomolecules 2022; 12:biom12020268. [PMID: 35204769 PMCID: PMC8961537 DOI: 10.3390/biom12020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Vitamin D has an immunomodulatory function and is involved in eliminating pathogens. Vitamin D deficiencies reported in Type 2 diabetes mellitus (T2DM) patients make them more susceptible to developing tuberculosis (TB). The macrophages are the immune cells that control intracellular pathogens by producing the antimicrobial peptide cathelicidin-LL37. This pathway involves TLR activation by pathogens, vitamin D receptor (VDR) ligation, and the enzyme 1α-hydroxylase Cytochrome P450 Family 27 Subfamily B Member 1 (CYP27B1). However, it is not clear whether the biological actions of vitamin D are affected by high glucose concentrations. This study aimed to evaluate the vitamin D contribution in the expression of VDR and CYP27B1, involved in the conversion of an inactive to an active form of vitamin D in the infected macrophages using M. tuberculosis as an infection model. The expression of LL37 and the nucleus translocation of VDR were evaluated as the readout of the response of vitamin D and determined if those processes are affected by glucose concentrations. Macrophages from healthy donors were cultured under glucose concentrations of 5.5, 15, or 30 mM, stimulated with vitamin D in inactive (25(OH)D3) or active (1,25(OH)2D3) forms, and infected with M. tuberculosis. The vitamin D-dependent induction of LL37 and the expression of VDR and CYP27B1 genes were analyzed by qPCR, and VDR translocation was analyzed in nuclear protein extracts by ELISA. M. tuberculosis downregulated the expression of LL37 regardless of the glucose concentration, whereas VDR and CYP27B1 upregulated it regardless of the glucose concentration. After evaluating two concentrations of vitamin D, 1 nM or 1 μM, the high concentration (1 μM) was necessary to restore the induction of LL37 expression in M. tuberculosis-infected macrophages. High concentrations of the inactive form of vitamin D restore the infected macrophages’ ability to express LL37 regardless of the glucose concentration. This finding supports the idea that vitamin D administration in patients with T2DM could benefit TB control and prevention.
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Affiliation(s)
- María Teresa Herrera
- Department of Microbiology Research, National Institute for Respiratory Diseases, Ismael Cosío Villegas, Mexico City 14080, Mexico; (M.T.H.); (E.J.); (S.G.-B.)
| | - Esmeralda Juárez
- Department of Microbiology Research, National Institute for Respiratory Diseases, Ismael Cosío Villegas, Mexico City 14080, Mexico; (M.T.H.); (E.J.); (S.G.-B.)
| | - Silvia Guzmán-Beltrán
- Department of Microbiology Research, National Institute for Respiratory Diseases, Ismael Cosío Villegas, Mexico City 14080, Mexico; (M.T.H.); (E.J.); (S.G.-B.)
| | - Martha Torres
- Biomedical Research Sub Direction, National Institute for Respiratory Diseases, Ismael Cosío Villegas, Mexico City 14080, Mexico;
| | - Victor Adrián Luna-Morales
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City 14080, Mexico; (V.A.L.-M.); (L.D.V.-A.)
| | | | - Yolanda González
- Department of Microbiology Research, National Institute for Respiratory Diseases, Ismael Cosío Villegas, Mexico City 14080, Mexico; (M.T.H.); (E.J.); (S.G.-B.)
- Correspondence: ; Tel.: +(52)-55-5487-1734; Fax: +(52)-55-5487-1700 (ext. 5117)
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Jerene D, Muleta C, Ahmed A, Tarekegn G, Haile T, Bedru A, Gebhard A, Wares F. High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia. J Clin Tuberc Other Mycobact Dis 2022; 27:100306. [PMID: 35284658 PMCID: PMC8904591 DOI: 10.1016/j.jctube.2022.100306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes. Methods Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist. Results Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more “symptoms” of DM was a significant predictor (OR 2.88, 95% CI, 2.06–4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high. Conclusions Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection.
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Affiliation(s)
- Degu Jerene
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
- Corresponding author at: KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB Den Haag, Netherlands.
| | - Chaltu Muleta
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Abdurezak Ahmed
- Addis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, Ethiopia
| | - Getahun Tarekegn
- Addis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, Ethiopia
| | - Tewodros Haile
- Addis Ababa University, College of Health Sciences and Tikur Anbessa Specialized Hospital, Department of Internal Medicine, Pulmonary and Critical Care Medicine Unit, Addis Ababa, Ethiopia
| | - Ahmed Bedru
- KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Agnes Gebhard
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
| | - Fraser Wares
- KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands
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15
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Huber FG, Kristensen KL, Holden IK, Andersen PH, Bakir B, Jørgensen A, Lorentsson HJN, Bjorn-Mortensen K, Johansen IS, Ravn P. The prevalence of diabetes among tuberculosis patients in Denmark. BMC Infect Dis 2022; 22:64. [PMID: 35045811 PMCID: PMC8767681 DOI: 10.1186/s12879-022-07048-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
SETTING It is estimated that 25% of the world's population are infected with Mycobacterium tuberculosis and that 463 million people are living with diabetes mellitus (DM), a number that is increasing. Patients with DM have three times the risk of developing tuberculosis (TB) and there is significant interaction between DM and TB, suggesting that DM affects not only risk of TB but also TB presentation, treatment response and outcome. OBJECTIVE The aim was determining the prevalence of DM among TB patients in Denmark and to assess risk factors. DESIGN Patient files from all notified TB cases in Denmark from 2009 to 2014 were retrospectively assessed. RESULTS In total, 1912 patients were included and 5.0% had DM. Patients with DM were older, had more comorbidities, came from outside Denmark, and had a higher mortality compared to non-DM-patients. None of the patients from Greenland had DM. Patients with low socio-economic status had a low prevalence of DM. We found a higher prevalence of DM among Danish-born < 54 year and migrant ≥ 75 year compared to a Danish background population. CONCLUSION We found a higher prevalence of DM among TB patients with known risk factors, and a surprisingly low prevalence among patients with low socioeconomic status and patients from Greenland.
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Affiliation(s)
| | | | | | | | - Banoo Bakir
- Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | - Anja Jørgensen
- Gentofte Hospital, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | | | - Karen Bjorn-Mortensen
- Gentofte Hospital, Copenhagen, Denmark
- Greenlands Center for Health Research, Ilisimatusarfik, Nuuk, Greenland
| | - Isik Somuncu Johansen
- Odense University Hospital, Odense, Denmark
- Mycobacteria Centre for Research Southern Denmark, Odense, Denmark
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16
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Kumar NP, Moideen K, Viswanathan V, Sivakumar S, Hissar S, Kornfeld H, Babu S. Effect of anti-tuberculosis treatment on the systemic levels of tissue inhibitors of metalloproteinases in tuberculosis - Diabetes co-morbidity. J Clin Tuberc Other Mycobact Dis 2021; 23:100237. [PMID: 33997311 PMCID: PMC8100611 DOI: 10.1016/j.jctube.2021.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives To study the association of Tissue inhibitors of matrix metalloproteinases (TIMP) levels with tuberculosis-diabetes comorbidity (TB-DM) comorbidity at baseline and in response to anti-TB treatment (ATT). Methods We examined the levels of TIMP-1, -2, -3 and -4 in pulmonary tuberculosis alone (TB) or TB-DM at baseline and after ATT. Results TIMP-1, -3 and -4 were significantly increased in TB-DM compared to TB at baseline and after ATT. ATT resulted in a significant reduction in TIMP-2 and -3 levels and a significant increase in TIMP-1 in both TB and TB-DM. TIMP-1, -3 and -4 were also significantly increased in TB-DM individuals with bilateral, cavitary disease and also exhibited a positive relationship with bacterial burden in TB-DM and HbA1c in all TB individuals. Within the TB-DM group, those known to be diabetic before incident TB (KDM) exhibited higher levels of TIMP-1, -2, -3 and -4 at baseline and TIMP-2 at post-treatment compared to those newly diagnosed with DM (NDM). KDM individuals on metformin treatment exhibited lower levels of TIMP-1, -2 and -4 at baseline and of TIMP-4 at post-treatment. Conclusions TIMP levels were elevated in TB-DM, associated with disease severity and bacterial burden, correlated with HbA1c levels and modulated by duration of DM and metformin treatment.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health - NIRT - International Center for Excellence in Research, Chennai, India.,National Institute for Research in Tuberculosis, Chennai, India
| | - Kadar Moideen
- National Institutes of Health - NIRT - International Center for Excellence in Research, Chennai, India
| | | | | | - Syed Hissar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institutes of Health - NIRT - International Center for Excellence in Research, Chennai, India.,LPD, NIAID, NIH, MD, USA
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Asare-Baah M, Séraphin MN, Salmon LAT, Lauzardo M. Effect of mixed strain infections on clinical and epidemiological features of tuberculosis in Florida. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2021; 87:104659. [PMID: 33276149 PMCID: PMC7855629 DOI: 10.1016/j.meegid.2020.104659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
Mixed infections with genetically distinct Mycobacterium tuberculosis (MTB) strains within a single host have been documented in different settings; however, this phenomenon is rarely considered in the management and care of new and relapse tuberculosis (T.B.) cases. This study aims to establish the epidemiological and clinical features of mixed infections among culture-confirmed T.B. patients enrolled in tuberculosis care at the Florida Department of Health (FDOH) and measure its association with T.B. mortality. We analyzed de-identified surveillance data of T.B. cases enrolled in T.B. care from April 2008 to January 2018. Mixed MTB infection was determined by the presence of more than one Copy Number Variant (CNV) in at least one locus, based on the genotype profile pattern of at least one isolate using 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR). The prevalence of mixed MTB infections among the 4944 culture-confirmed TB cases included in this analysis was 2.6% (129). Increased odds of mixed infections were observed among middle-aged patients, 45-64 years (AOR = 2.38; 95% CI: 0.99, 5.69; p = 0.0513), older adults 65 years and above (AOR = 3.95; 95% CI: 1.63, 9.58; p = 0.0023) and patients with diabetes (OR = 1.77; 95% CI: 1.12, 2.80; p = 0.0150). There was no significant association between mixed infections and death. Our study provides insight into the epidemiological and clinical characteristics of patients with mixed MTB infections, which is essential in the management of T.B. patients.
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Affiliation(s)
- Michael Asare-Baah
- Department of Epidemiology, University of Florida, College of Public Health and Health Professions, College of Medicine, 2004 Mowry Road, P.O. Box 100231, Gainesville, FL 32610, United States; Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, United States.
| | - Marie Nancy Séraphin
- Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, United States; Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, United States
| | - LaTweika A T Salmon
- Florida Department of Health, Bureau of Tuberculosis Control, 4052 Bald Cypress Way, Bin A-20, Tallahassee, FL 32399, United States
| | - Michael Lauzardo
- Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, United States; Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, United States
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Qiu X, Wang H, Tang Y, Su X, Ge L, Qu Y, Mu D. Is interleukin-2 an optimal marker for diagnosing tuberculosis infection? A systematic review and meta-analysis. Ann Med 2020; 52:376-385. [PMID: 32700645 PMCID: PMC7877967 DOI: 10.1080/07853890.2020.1800073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Latent tuberculosis infection (LTBI) is a huge reservoir for the deadlier TB disease. Accurate identification of LTBI is a key strategy to eliminate TB. Therefore, a systematic review and meta-analysis approach was used to assess diagnostic potential of IL-2 for LTBI. METHODS PubMed, Web of Science, the Cochrane Library and Embase were searched. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUROC) and hierarchical summary receiver operating characteristic curve (HSROC) were estimated by bivariate and HSROC models. RESULTS Twenty-seven studies including 1404 participants and 1986 samples met the inclusion criteria. The pooled sensitivity, specificity, PLR, NLR, DOR and AUROC of IL-2 were separately as 87%, 98%, 34.78, 0.14, 256.41 and 0.98, indicating a very powerful differentiating ability of IL-2 for LTBI from non-TB controls. For differentiating ATB from LTBI, the pooled sensitivity, specificity, PLR, NLR, DOR and AUROC of IL-2 were 83%, 76%, 3.41, 0.22, 15.47 and 0.87, respectively, suggesting a good differentiating ability of IL-2. CONCLUSIONS These findings showed that IL-2 is a powerful marker for differentiating LTBI from non-TB controls and a good marker for differentiating ATB from LTBI individuals.
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Affiliation(s)
- Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Huiqing Wang
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Ying Tang
- Department of Ultrasonic, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaojuan Su
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
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Fonseca AAD, Pinto ACG, Paixão TPD, Albério CAA, Vieira JLF. Can diabetes mellitus modify the plasma concentrations of rifampicin in patients under treatment for tuberculosis? Braz J Infect Dis 2020; 24:352-355. [PMID: 32535111 PMCID: PMC9392073 DOI: 10.1016/j.bjid.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022] Open
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20
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Wang Q, Ma A, Gao T, Liu Y, Ren L, Han L, Wei B, Liu Q, Dong C, Mu Y, Li D, Kok FJ, Schouten EG. Poor Vitamin D Status in Active Pulmonary Tuberculosis Patients and Its Correlation with Leptin and TNF-α. J Nutr Sci Vitaminol (Tokyo) 2020; 65:390-398. [PMID: 31666475 DOI: 10.3177/jnsv.65.390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vitamin D deficiency (VDD) is common in tuberculosis (TB) and may be implicated in the etiology of the disease and in its clinical course. The aim of this study was to investigate the association between leptin, inflammatory markers and VD status in TB patients, stratified for presence or absence of diabetes mellitus (DM). Two hundred ninety-nine TB patients were recruited from October 2015 to August 2016. Also, 91 normal controls were included. The information including socio-demographics, dietary intake and living habits was obtained by face-to-face interview. Serum concentrations of leptin and TNF-α, CRP and IL-6 were compared between TB patients with and without severe VDD (SVDD). Pearson's correlation was used to analyze the association between TNF-α, leptin and 25-hydroxyvitamin D (25(OH)D). A significantly higher prevalence of VDD and SVDD was observed in TB patients compared with normal controls (93.0% vs 70.3%, 65.9% vs 3.3% respectively). Concentration of leptin was significantly lower, while TNF-α higher in TB patients with SVDD compared to those without (p<0.05). After adjustment for confounders, leptin was positively associated with 25(OH)D (r=0.210, p=0.002) with similar correlation in TB patients with DM (r=0.240, p=0.020). A negative association between TNF-α and 25(OH)D was observed (r=-0.197, p=0.003), which was significant only in the subgroup without DM (r=-0.304, p=0.001). Our findings indicate that a higher VD status in TB patients may be related to higher immune activity and less serious tissue damage, and that this relation is different according to presence or absence of DM co-morbidity.
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Affiliation(s)
- Qiuzhen Wang
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Aiguo Ma
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Tianlin Gao
- Institute of Human Nutrition, Medical College of Qingdao University
| | | | - Lisheng Ren
- The Affiliated Hospital of Qingdao University
| | - Lei Han
- The Affiliated Hospital of Qingdao University
| | - Boyang Wei
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Qian Liu
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Chunjiang Dong
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Yuze Mu
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Duo Li
- Institute of Human Nutrition, Medical College of Qingdao University
| | - Frans J Kok
- Division of Human Nutrition, Wageningen University
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21
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Radhakrishnan RK, Thandi RS, Tripathi D, Paidipally P, McAllister MK, Mulik S, Samten B, Vankayalapati R. BCG vaccination reduces the mortality of Mycobacterium tuberculosis-infected type 2 diabetes mellitus mice. JCI Insight 2020; 5:133788. [PMID: 32161191 DOI: 10.1172/jci.insight.133788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
Diabetes is a significant risk factor for the development of active tuberculosis. In this study, we used a mouse model of type 2 diabetes mellitus (T2DM) to determine the effect of prior Bacillus Calmette-Guérin (BCG) vaccination on immune responses to Mycobacterium tuberculosis (Mtb) infection. We found that, at 6-7 months after Mtb infection, 90% of the Mtb-infected T2DM mice died, whereas only 50% of BCG-vaccinated T2DM-Mtb-infected mice died. Moreover, 40% of the PBS-treated uninfected T2DM mice and 30% of the uninfected BCG-vaccinated T2DM mice died, whereas all uninfected and infected nondiabetic mice survived. BCG vaccination was less effective in reducing the lung bacterial burden of Mtb-infected T2DM mice compared with Mtb-infected nondiabetic mice. BCG vaccination significantly reduced lung inflammation in Mtb-infected T2DM mice compared with that of unvaccinated T2DM mice infected with Mtb. Furthermore, reduced mortality of BCG-vaccinated Mtb-infected T2DM mice is associated with expansion of IL-13-producing CXCR3+ Tregs in the lungs of Mtb-infected T2DM mice. Recombinant IL-13 and Tregs from BCG-vaccinated Mtb-infected T2DM mice converted proinflammatory M1 macrophages to antiinflammatory M2 macrophages. Our findings suggest a potentially novel role for BCG in preventing excess inflammation and mortality in T2DM mice infected with Mtb.
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22
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Kumar NP, Moideen K, Nancy A, Viswanathan V, Shruthi BS, Sivakumar S, Hissar S, Kornfeld H, Babu S. Systemic RAGE ligands are upregulated in tuberculosis individuals with diabetes co-morbidity and modulated by anti-tuberculosis treatment and metformin therapy. BMC Infect Dis 2019; 19:1039. [PMID: 31818258 PMCID: PMC6902343 DOI: 10.1186/s12879-019-4648-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background Ligands of the receptor for advanced glycation end products (RAGE) are key signalling molecules in the innate immune system but their role in tuberculosis-diabetes comorbidity (TB-DM) has not been investigated. Methods We examined the systemic levels of soluble RAGE (sRAGE), advanced glycation end products (AGE), S100A12 and high mobility group box 1 (HMGB1) in participants with either TB-DM, TB, DM or healthy controls (HC). Results Systemic levels of AGE, sRAGE and S100A12 were significantly elevated in TB-DM and DM in comparison to TB and HC. During follow up, AGE, sRAGE and S100A12 remained significantly elevated in TB-DM compared to TB at 2nd month and 6th month of anti-TB treatment (ATT). RAGE ligands were increased in TB-DM individuals with bilateral and cavitary disease. sRAGE and S100A12 correlated with glycated hemoglobin levels. Within the TB-DM group, those with known diabetes (KDM) revealed significantly increased levels of AGE and sRAGE compared to newly diagnosed DM (NDM). KDM participants on metformin treatment exhibited significantly diminished levels of AGE and sRAGE in comparison to those on non-metformin regimens. Conclusions Our data demonstrate that RAGE ligand levels reflect disease severity and extent in TB-DM, distinguish KDM from NDM and are modulated by metformin therapy.
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Affiliation(s)
- Nathella Pavan Kumar
- National Institutes of Health-NIRT- International Center for Excellence in Research, No. 1 Mayor Sathyamoothy Road, Chetpet, Chennai, India.
| | - Kadar Moideen
- National Institutes of Health-NIRT- International Center for Excellence in Research, No. 1 Mayor Sathyamoothy Road, Chetpet, Chennai, India
| | - Arul Nancy
- National Institutes of Health-NIRT- International Center for Excellence in Research, No. 1 Mayor Sathyamoothy Road, Chetpet, Chennai, India.,Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | | | | | | | - Syed Hissar
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institutes of Health-NIRT- International Center for Excellence in Research, No. 1 Mayor Sathyamoothy Road, Chetpet, Chennai, India.,LPD, NIAID, NIH, Bethesda, MD, USA
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23
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Tenaye L, Mengiste B, Baraki N, Mulu E. Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7640836. [PMID: 31781641 PMCID: PMC6875401 DOI: 10.1155/2019/7640836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/17/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. METHODOLOGY We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. RESULT The prevalence of diabetes mellitus in this study was 13.5%. Age 26-40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. CONCLUSION This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.
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Affiliation(s)
- Lucy Tenaye
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Negga Baraki
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Ermiyas Mulu
- College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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24
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Leal ML, Maciel ELN, Cade NV. Factors associated with tuberculosis in a population of diabetics: A case-control study. CIENCIA & SAUDE COLETIVA 2019; 24:3247-3256. [PMID: 31508745 DOI: 10.1590/1413-81232018249.30392017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/09/2018] [Indexed: 01/18/2023] Open
Abstract
This study analyzed the factors associated with tuberculosis in diabetics seen at health units of Vitória, ES, Brazil. This is a case-control study of 45 cases of diabetics seen in the 30 units of the municipality and reported in the SINAN with a diagnosis of tuberculosis in the 2007-2013 period and 90 cases of diabetic controls. We used data from the SINAN, the Health Information System of Vitória, and the Central Municipal Laboratory, as well a structured interview. Bivariate and multivariate analyses were performed, using logistic regression with the significant variables (p < 0.05). The case group presented a higher frequency of health-damaging life habits as compared to the control group, such as compulsive drinking (p < 0.001) and tobacco smoking (p = 0.060), as well as worse biochemical parameters, such as fasting blood sugar (p < 0.001) and glycosylated hemoglobin (p = 0.034). Regular drinking (OR 6.612, CI 2,151-20.330), previous contact with people with tuberculosis (OR 4.418, CI 1.678-11.631), and fasting blood sugar (OR 1.017, CI 1.007-1.026) were associated with tuberculosis in diabetics. The study reveals that poorer lifestyle habits and glycemic control and previous contact with active tuberculosis increase the chance of diabetics developing tuberculosis.
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Affiliation(s)
- Marcelle Lemos Leal
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
| | - Ethel Leonor Nóia Maciel
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
| | - Nágela Valadão Cade
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
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25
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Kubiak RW, Sarkar S, Horsburgh CR, Roy G, Kratz M, Reshma A, Knudsen S, Salgame P, Ellner JJ, Drain PK, Hochberg NS. Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis 2019; 19:627. [PMID: 31311495 PMCID: PMC6636094 DOI: 10.1186/s12879-019-4244-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. METHODS We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. RESULTS Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. CONCLUSIONS BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mario Kratz
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, USA.,Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Ayiraveetil Reshma
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Selby Knudsen
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA
| | - Jerrold J Ellner
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA.,Boston Medical Center, Boston, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Natasha S Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Boston Medical Center, Boston, USA
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26
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Balakrishnan S, Rakesh PS, Viswanathan K, Nelson V, Simon S, Nair SA, Mathew ME, Sunilkumar M. Higher risk of developing active TB among adult diabetics exposed to TB during childhood: A study from Kerala, India. J Family Med Prim Care 2019; 8:695-700. [PMID: 30984697 PMCID: PMC6436278 DOI: 10.4103/jfmpc.jfmpc_344_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Factors associated with tuberculosis (TB) in Kerala, the southern Indian state that notifies approximately 33 microbiologically confirmed new cases per 100,000 population every year for the past two decades, are still unclear. We did a community-based case-control study in Kollam district, Kerala, to identify the individual-level risk factors for TB. METHODS Structured questionnaire was applied to 101 microbiologically confirmed new TB cases registered under Revised National Tuberculosis Control Program and 202 age- and gender-matched neighborhood controls without present or past TB. Information was sought on socioeconomic status (SES), smoking, consumption of alcohol, close contact with active TB during childhood or recent past, diabetes mellitus (DM), and other comorbid conditions. RESULTS Close contact with TB during childhood [odds ratio (OR) 15.88, 95% confidence interval (CI) 3.21-78.55], recent close contact with TB (OR 4.81, 95% CI 2.09-11.07), DM (OR 1.64, 95% CI 1.04-3.06), SES (OR 2.16, 95% CI 1.16-4.03), smoking more than 10 cigarettes/beedis per day (OR 3.32, 95% CI 1.27-8.96), consuming more than 10 standard drinks per week (OR 2.91, 95% CI 1.33-6.37), and the interaction term of having close contact with TB during childhood and DM at present (OR 7.37, 95% CI 1.18-50.29) were found to be associated with TB. CONCLUSION Close contact with a case of TB, presence of DM, lower SES, smoking, and alcohol consumption were associated with active TB in Kollam. Having close contact with a case of TB during childhood and development of DM in later life together are significantly associated with active TB in the study population. The findings also direct further studies to confirm and explore mechanisms of interaction of diabetes with childhood exposure to TB.
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Affiliation(s)
| | - P. S. Rakesh
- Amrita Institute of Medical Sciences, Amrita University, Kochi, India
| | | | - Vincy Nelson
- Community Medicine, Travancore Medical College, Kollam, India
| | - Sony Simon
- Biostatistics, Travancore Medical College, Kollam, India
| | - Sreenivas A. Nair
- World Health Organisation, RNTCP Technical Assistance Project, India
| | - Manu E. Mathew
- World Health Organisation, RNTCP Technical Assistance Project, India
| | - M. Sunilkumar
- State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India
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27
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Erzse A, Stacey N, Chola L, Tugendhaft A, Freeman M, Hofman K. The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study. Glob Health Action 2019; 12:1636611. [PMID: 31282315 PMCID: PMC7012049 DOI: 10.1080/16549716.2019.1636611] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is known to require continuous clinical care and management that consumes significant health-care resources. These costs are not well understood, particularly in low- and middle-income countries. Objective: The aim of this study was to estimate the direct medical costs associated with T2DM in the South African public health sector and to project an estimate of the future direct costs of T2DM by 2030. Methods: A cost of illness study was conducted to estimate the direct medical costs of T2DM in South Africa in 2018 and to make projections for potential costs in 2030. Costs were estimated for diagnosis and management of T2DM, and related complications. Analyses were implemented in Microsoft Excel, with sensitivity analysis conducted on particular parameters. Results: In 2018, public sector costs of diagnosed T2DM patients were approximately ZAR 2.7 bn and ZAR 21.8 bn if both diagnosed and undiagnosed patients are considered. In real terms, the 2030 cost of all T2DM cases is estimated to be ZAR 35.1 bn. Approximately 51% of these estimated costs for 2030 are attributable to the management of T2DM, and 49% are attributable to complications. Conclusion: T2DM imposes a significant financial burden on the public healthcare system in South Africa. Treatment of all prevalent cases would incur a cost equivalent to approximately 12% of the total national health budget in 2018. With rising prevalence, direct costs will grow if current care regimes are maintained and case-finding improved. Increased financial resources are necessary in order to deliver effective services to people with T2DM.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicholas Stacey
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lumbwe Chola
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aviva Tugendhaft
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melvyn Freeman
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rashak HA, Sánchez-Pérez HJ, Abdelbary BE, Bencomo-Alerm A, Enriquez-Ríos N, Gómez-Velasco A, Colorado A, Castellanos-Joya M, Rahbar MH, Restrepo BI. Diabetes, undernutrition, migration and indigenous communities: tuberculosis in Chiapas, Mexico. Epidemiol Infect 2019; 147:e71. [PMID: 30869023 PMCID: PMC6518577 DOI: 10.1017/s0950268818003461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/04/2018] [Accepted: 11/23/2018] [Indexed: 11/06/2022] Open
Abstract
We investigated the distribution of comorbidities among adult tuberculosis (TB) patients in Chiapas, the poorest Mexican state, with a high presence of indigenous population, and a corridor for migrants from Latin America. Secondary analysis on 5508 new adult TB patients diagnosed between 2010 and 2014 revealed that the most prevalent comorbidities were diabetes mellitus (DM; 19.1%) and undernutrition (14.4%). The prevalence of DM in these TB patients was significantly higher among middle aged (41-64 years) compared with older adults (⩾65 years) (38.6% vs. 23.2%; P < 0.0001). The prevalence of undernutrition was lower among those with DM, and higher in communities with high indigenous presence. Immigrants only comprised 2% of all TB cases, but were more likely to have unfavourable TB treatment outcomes (treatment failure, death and default) when compared with those born in Chiapas (29.5% vs. 11.1%; P < 0.05). Unfavourable TB outcomes were also more prevalent among the TB patients with undernutrition, HIV or older age, but not DM (P < 0.05). Our study in Chiapas illustrates the challenges of other regions worldwide where social (e.g. indigenous origin, poverty, migration) and host factors (DM, undernutrition, HIV, older age) are associated with TB. Further understanding of these critical factors will guide local policy makers and health providers to improve TB management.
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Affiliation(s)
- H. A. Rashak
- University of Texas Health Houston, School of Public Health, Brownsville Campus, Brownsville, TX, 78520, USA
| | - H. J. Sánchez-Pérez
- Research Network GRAAL (Research Groups for Africa and Latin America), The College of the South Border (ECOSUR),San Cristobal de Las Casas Chiapas, Mexico
| | - B. E. Abdelbary
- Department of Physician Assistant, University of Texas Rio Grande Valley, College of Health Affairs, Edinburg campus, Edinburg, TX, 78541, USA
| | - A. Bencomo-Alerm
- GRAAL, Prevention and Control Program of Tuberculosis in the Highlands Region of Chiapas, Ministry of Health of Chiapas, Chiapas, Mexico
| | - N. Enriquez-Ríos
- Transmissible and Non-transmissible Diseases Department, Ministry of Health of Chiapas, Chiapas, Mexico
| | - A. Gómez-Velasco
- Research Network GRAAL (Research Groups for Africa and Latin America), The College of the South Border (ECOSUR),San Cristobal de Las Casas Chiapas, Mexico
| | - A. Colorado
- Advocate and International Public Health Consultant Fighting Tuberculosis, HIV/AIDS and other Neglected Diseases, San Diego, California, USA
| | | | - M. H. Rahbar
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Centre at Houston, Houston, Texas, USA
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, and The Centre for Clinical and Translational Sciences, University of Texas Health Science Centre at Houston, Houston, Texas, USA
| | - B. I. Restrepo
- University of Texas Health Houston, School of Public Health, Brownsville Campus, Brownsville, TX, 78520, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Centre at Houston, Houston, Texas, USA
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29
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McMurry HS, Mendenhall E, Rajendrakumar A, Nambiar L, Satyanarayana S, Shivashankar R. Coprevalence of type 2 diabetes mellitus and tuberculosis in low-income and middle-income countries: A systematic review. Diabetes Metab Res Rev 2019; 35:e3066. [PMID: 30144270 DOI: 10.1002/dmrr.3066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/12/2018] [Accepted: 08/18/2018] [Indexed: 11/09/2022]
Abstract
Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.
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Affiliation(s)
- Hannah Stowe McMurry
- University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Chronic Disease Control, Delhi, India
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - Lavanya Nambiar
- Public Health Foundation of India, Delhi, India
- Department of Health Policy, Management Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, Delhi, India
- Public Health Foundation of India, Delhi, India
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30
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Pearson F, Huangfu P, McNally R, Pearce M, Unwin N, Critchley JA. Tuberculosis and diabetes: bidirectional association in a UK primary care data set. J Epidemiol Community Health 2018; 73:142-147. [PMID: 30377249 DOI: 10.1136/jech-2018-211231] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many studies have found an increased risk of pulmonary tuberculosis (PTB) among those with diabetes mellitus (DM). However, evidence on whether the association is bidirectional remains sparse. This study investigates DM rates among those with and without prior tuberculosis (TB) disease as well as the reverse. METHODS Data on a UK general practice population, between 2003 and 2009, were obtained from The Health Improvement Network database. A series of retrospective cohort studies were completed. Individuals were successively classified as 'exposed' or 'unexposed' to TB, PTB, extrapulmonary TB (EPTB) or DM. Multivariate negative binomial regression was used to calculate incidence rate ratios (IRR) among each exposure group for outcomes of interest (TB, PTB, EPTB or DM in turn) adjusting for plausible confounding variables (age, sex, region, Townsend quintile and smoking status). Potential confounding due to ethnicity was adjusted for using McNamee's external method. RESULTS DM risk was substantially raised among individuals with a history of TB disease (IRR 5.65 (95% CI 5.19 to 6.16)), PTB (IRR 5.74 (95% CI 5.08 to 6.50)) and EPTB (IRR 4.66 (95% CI 3.94 to 5.51)) compared with those without; results were attenuated after external adjustment for ethnicity (IRR 2.33 (95% CI 2.14 to 2.53)). TB risk was raised modestly among individuals with DM (IRR 1.50 (95% CI 1.27 to 1.76)) and was attenuated slightly after adjustment for ethnicity (IRR 1.26 (95% CI 1.07 to 1.48)). CONCLUSION DM risk was raised among those with previous TB disease; this finding has implications for follow-up and screening of patients with TB, who may be at high risk of developing DM or related complications.
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Affiliation(s)
- Fiona Pearson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Peijue Huangfu
- Population Health Research Institute, St George's, University of London, London, UK
| | - Richard McNally
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
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Lee YJ, Han SK, Park JH, Lee JK, Kim DK, Chung HS, Heo EY. The effect of metformin on culture conversion in tuberculosis patients with diabetes mellitus. Korean J Intern Med 2018; 33. [PMID: 29540054 PMCID: PMC6129638 DOI: 10.3904/kjim.2017.249] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Patients with diabetes mellitus (DM) and tuberculosis (TB) have increased morbidity and a high risk of treatment failure or recurrence. It is important to manage both diseases simultaneously. Among anti-diabetic drugs, metformin inhibits intracellular growth of mycobacteria. Therefore, we examined the effects of metformin on TB treatment, especially in patients with DM. METHODS This retrospective cohort study included patients with culture-positive pulmonary TB diagnosed between 2011 and 2012. The primary study outcome was sputum culture conversion after 2 months of treatment. RESULTS Of 499 patients diagnosed with culture-positive pulmonary TB, 105 (21%) had DM at diagnosis. Among them, 62 (59.5%) were treated with metformin. Baseline characteristics, except for the presence of chronic renal disease, were not significantly different between the metformin and non-metformin groups. Metformin treatment had no significant effect on sputum culture conversion (p = 0.60) and recurrence within 1 year after TB treatment completion (p = 0.39). However, metformin improved the sputum culture conversion rate in patients with cavitary pulmonary TB, who have higher bacterial loads (odds ratio, 10.8; 95% confidence interval, 1.22 to 95.63). CONCLUSION Among cavitary pulmonary TB patients with DM, metformin can be an effective adjunctive anti-TB agent to improve sputum culture conversion after 2 months of treatment.
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Affiliation(s)
- Ye-Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Keom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Soon Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- Correspondence to Eun Young Heo, M.D. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-3207 Fax: +82-2-831-0714 E-mail:
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Tripathi D, Welch E, Cheekatla SS, Radhakrishnan RK, Venkatasubramanian S, Paidipally P, Van A, Samten B, Devalraju KP, Neela VSK, Valluri VL, Mason C, Nelson S, Vankayalapati R. Alcohol enhances type 1 interferon-α production and mortality in young mice infected with Mycobacterium tuberculosis. PLoS Pathog 2018; 14:e1007174. [PMID: 30071107 PMCID: PMC6072099 DOI: 10.1371/journal.ppat.1007174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/24/2018] [Indexed: 12/31/2022] Open
Abstract
In the current study, we used a mouse model and human blood samples to determine the effects of chronic alcohol consumption on immune responses during Mycobacterium tuberculosis (Mtb) infection. Alcohol increased the mortality of young mice but not old mice with Mtb infection. CD11b+Ly6G+ cells are the major source of IFN-α in the lungs of Mtb-infected alcohol-fed young mice, and IFN-α enhances macrophage necroptosis in the lungs. Treatment with an anti-IFNAR-1 antibody enhanced the survival of Mtb-infected alcohol-fed young mice. In response to Mtb, peripheral blood mononuclear cells (PBMCs) from alcoholic young healthy individuals with latent tuberculosis infection (LTBI) produced significantly higher amounts of IFN-α than those from non-alcoholic young healthy LTBI+ individuals and alcoholic and non-alcoholic old healthy LTBI+ individuals. Our study demonstrates that alcohol enhances IFN-α production by CD11b+Ly6G+ cells in the lungs of young Mtb-infected mice, which leads to macrophage necroptosis and increased mortality. Our findings also suggest that young alcoholic LTBI+ individuals have a higher risk of developing active TB infection. Chronic alcohol consumption modulates the host immune defense mechanism(s) and makes the host susceptible to various fungal, viral and bacterial infections, including Mycobacterium tuberculosis (Mtb). However, limited information is available about the mechanisms involved in alcohol-mediated host susceptibility to Mtb and other intracellular bacterial infections. In the current study, we fed control and alcohol diets to young and old mice and determined the mortality rates and the immune mechanisms involved in host susceptibility to Mtb infection. We found that alcohol increases the mortality of young mice but not old mice infected with Mtb. The increased mortality in alcohol-fed Mtb-infected young mice was due to IFN-α production by CD11b+Ly6G+ cells. We also found that PBMCs from young alcoholic individuals with latent tuberculosis infection (LTBI) produced significantly higher amounts of IFN-α than those from young non-alcoholic, old alcoholic and old non-alcoholic LTBI+ individuals. Our findings suggest that young alcoholic LTBI+ individuals have a higher risk of developing active TB infection. Our studies provide the first evidence that chronic alcohol consumption induces IFN-α production in young Mtb-infected mice and increases their mortality rates. Further characterization of CD11b+Ly6G+ cells and delineation of the mechanisms through which alcohol enhances IFN-α production in Ly6G+ cells during Mtb infection will facilitate the development of therapies for alcoholic individuals with latent and active Mtb.
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Affiliation(s)
- Deepak Tripathi
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Elwyn Welch
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Satyanarayana Swamy Cheekatla
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Rajesh Kumar Radhakrishnan
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Sambasivan Venkatasubramanian
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Padmaja Paidipally
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Abhinav Van
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Buka Samten
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | | | | | | | - Carol Mason
- Department of Medicine, Section of Pulmonary/Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Steve Nelson
- Department of Medicine, Section of Pulmonary/Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ramakrishna Vankayalapati
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
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Sánchez-Jiménez R, Cerón E, Bernal-Alcántara D, Castillejos-López M, Gonzalez-Trujano E, Negrete-García MC, Alvarado-Vásquez N. Association between IL-15 and insulin plasmatic concentrations in patients with pulmonary tuberculosis and type 2 diabetes. Tuberculosis (Edinb) 2018; 111:114-120. [PMID: 30029895 DOI: 10.1016/j.tube.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Abstract
IL-15 is part of the immune response in pulmonary tuberculosis (PTB) but amazingly, it may also induce physiological effects similar to those of insulin. We evaluated the IL-15 and insulin plasmatic levels in adults with PTB and with or without type 2 diabetes mellitus (DM2), who received previous antituberculosis therapy for at least 2 months. We analyzed the concentrations of glucose, glycated hemoglobin, insulin, as well as levels of IL-15, IL-2, IFN-γ, and TNF-α in patients with PTB, patients with PTB-DM2, household contacts with DM2 (C-DM2), and healthy household contacts (H-C). Our results showed unexpected high levels of glucose, insulin, and IL-15 in the PTB and C-DM2 groups. In comparison, low levels of these same indicators were observed in the PTB-DM2 and H-C groups. Interestingly, our analysis showed a positive correlation of IL-15 with insulin in the PTB group (r = 0.73) and in the C-DM2 group (r = 0.66). In comparison, a weak correlation between IL-15 and insulin was observed in the PTB-DM group (r = 0.10) and in the H-C group (ρ = 0.26). Our results suggest an association between IL-15 and insulin levels in the patient with PTB. Intriguingly, this association was weaker in the patient with PTB-DM2.
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Affiliation(s)
- Roberto Sánchez-Jiménez
- Graduate and Research Section, Higher School of Medicine of the National Polytechnic Institute, Mexico City, 11340, Mexico
| | - Eduarda Cerón
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Demetrio Bernal-Alcántara
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Manuel Castillejos-López
- Epidemiological Surveillance Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Eva Gonzalez-Trujano
- National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, 14370, Mexico
| | - Maria Cristina Negrete-García
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico
| | - Noé Alvarado-Vásquez
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, 14080, Mexico.
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Esmail A, Sabur NF, Okpechi I, Dheda K. Management of drug-resistant tuberculosis in special sub-populations including those with HIV co-infection, pregnancy, diabetes, organ-specific dysfunction, and in the critically ill. J Thorac Dis 2018; 10:3102-3118. [PMID: 29997980 DOI: 10.21037/jtd.2018.05.11] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tuberculosis remains a major problem globally, and is the leading cause of death from an infectious agent. Drug-resistant tuberculosis threatens to marginalise the substantial gains that have recently been made in the fight against tuberculosis. Drug-resistant TB has significant associated morbidity and a high mortality, with only half of all multidrug-resistant TB patients achieving a successful treatment outcome. Patients with drug-resistant TB in resource-poor settings are now gaining access to newer and repurposed anti-tuberculosis drugs such as bedaquiline, delamanid and linezolid. However, with ever increasing rates of co-morbidity, there is little guidance on how to manage complex patients with drug-resistant TB. We address that knowledge gap, and outline principles underpinning the management of drug-resistant TB in special situations including HIV co-infection, pregnancy, renal disease, liver disease, diabetes, and in the critically ill.
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Affiliation(s)
- Aliasgar Esmail
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Natasha F Sabur
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Respirology, Department of Medicine, St. Michael's Hospital and West Park Healthcare Centre, Toronto, Canada
| | - Ikechi Okpechi
- Division of Nephrology, Department of Medicine University of Cape Town, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya. J Clin Tuberc Other Mycobact Dis 2018; 12:9-13. [PMID: 31720392 PMCID: PMC6830184 DOI: 10.1016/j.jctube.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/28/2018] [Accepted: 04/09/2018] [Indexed: 12/27/2022] Open
Abstract
Background The double burden of diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the global health challenges. Studies done in different parts of the world indicate that 12%-44% of TB disease is associated with DM. In Kenya TB-DM co-morbidity data is scarce and is not readily available. In this study we set to determine the difference in treatment outcomes among TB and TB/DM comorbidity patients and their respective clinical and socio-demographic characteristics. Objective To determine prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya. Methods We carried out a prospective cohort study of non-pregnant patients aged 15 years and above that tested positive for TB in two peri‑urban counties in Kenya between February 2014 and August 2015. Clinical and socio demographic data were obtained from a questionnaire and medical records of the National TB program patient data base at two, three, five and six months. The data consisted of TB status, HIV status, TB lineage, County, (Glucose, %HbA1c, creatinine) weight, height, BMI, regimen, sex, level of education, employment status, distance from health facility, number of cigarettes smoked, home size, and diet. Univariate analysis was then used to compare each potential risk factor in the TB and TB/DM patients by the Pearson x2 test of proportions or fisher exact test, as appropriate. Results DM prevalence (HbA1c > 6%) among TB infected patients was 37.2%. Regimen, employment status, alcohol intake, smoking, age and household size were some of the factors associated with DM among TB patients at p-value < 0.05. The number of cigarettes smoked per day and the value of the BUN were significant risk factors of developing DM among TB patients (p values = 0.045). Mean time to conversion from positive to negative was slightly higher for the TB-DM patients compared to the TB patents, though not statistically significant (p = 0.365). Conclusion Patients regimen, employment status, alcohol intake, smoking, age and are associated with DM among TB patients.
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da Silva DAA, da Silva MV, Barros CCO, Alexandre PBD, Timóteo RP, Catarino JS, Sales-Campos H, Machado JR, Rodrigues DBR, Oliveira CJ, Rodrigues V. TNF-α blockade impairs in vitro tuberculous granuloma formation and down modulate Th1, Th17 and Treg cytokines. PLoS One 2018; 13:e0194430. [PMID: 29543912 PMCID: PMC5854376 DOI: 10.1371/journal.pone.0194430] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/03/2018] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis (TB) is a granulomatous disease that has affected humanity for thousands of years. The production of cytokines, such as IFN-γ and TNF-α, is fundamental in the formation and maintenance of granulomas and in the control of the disease. Recently, the introduction of TNF-α-blocking monoclonal antibodies, such as Infliximab, has brought improvements in the treatment of patients with chronic inflammatory diseases, but this treatment also increases the risk of reactivation of latent tuberculosis. Our objective was to analyze, in an in vitro model, the influence of Infliximab on the granulomatous reactions and on the production of antigen-specific cytokines (TNF-α, IFN-γ, IL-12p40, IL-10 and IL-17) from beads sensitized with soluble Bacillus Calmette-Guérin (BCG) antigens cultured in the presence of peripheral blood mononuclear cells (PBMC) from TB patients. We evaluated 76 individuals, with tuberculosis active, treated and subjects with positive PPD. Granuloma formation was induced in the presence or absence of Infliximab for up to 10 days. The use of Infliximab in cultures significantly blocked TNF-α production (p <0.05), and led to significant changes in granuloma structure, in vitro, only in the treated TB group. On the other hand, there was a significant reduction in the levels of IFN-γ, IL-12p40, IL-10 and IL-17 after TNF-α blockade in the three experimental groups (p <0.05). Taken together, our results demonstrate that TNF-α blockade by Infliximab directly influenced the structure of granuloma only in the treated TB group, but negatively modulated the production of Th1, Th17 and regulatory T cytokines in the three groups analyzed.
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Affiliation(s)
- Djalma A. Alves da Silva
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Marcos V. da Silva
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Cleyson C. Oliveira Barros
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | | | - Rodolfo P. Timóteo
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Jonatas S. Catarino
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Helioswilton Sales-Campos
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Juliana R. Machado
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Denise B. R. Rodrigues
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
- Laboratory of Biopathology and Molecular Biology, University of Uberaba, Uberaba, Minas Gerais, Brazil
| | - Carlo J. Oliveira
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | - Virmondes Rodrigues
- Laboratory of Immunology, Department of Biological Sciences, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
- * E-mail:
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Blanco-Guillot F, Castañeda-Cediel ML, Cruz-Hervert P, Ferreyra-Reyes L, Delgado-Sánchez G, Ferreira-Guerrero E, Montero-Campos R, Bobadilla-del-Valle M, Martínez-Gamboa RA, Torres-González P, Téllez-Vazquez N, Canizales-Quintero S, Yanes-Lane M, Mongua-Rodríguez N, Ponce-de-León A, Sifuentes-Osornio J, García-García L. Genotyping and spatial analysis of pulmonary tuberculosis and diabetes cases in the state of Veracruz, Mexico. PLoS One 2018. [PMID: 29534104 PMCID: PMC5849303 DOI: 10.1371/journal.pone.0193911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Genotyping and georeferencing in tuberculosis (TB) have been used to characterize the distribution of the disease and occurrence of transmission within specific groups and communities. Objective The objective of this study was to test the hypothesis that diabetes mellitus (DM) and pulmonary TB may occur in spatial and molecular aggregations. Material and methods Retrospective cohort study of patients with pulmonary TB. The study area included 12 municipalities in the Sanitary Jurisdiction of Orizaba, Veracruz, México. Patients with acid-fast bacilli in sputum smears and/or Mycobacterium tuberculosis in sputum cultures were recruited from 1995 to 2010. Clinical (standardized questionnaire, physical examination, chest X-ray, blood glucose test and HIV test), microbiological, epidemiological, and molecular evaluations were carried out. Patients were considered “genotype-clustered” if two or more isolates from different patients were identified within 12 months of each other and had six or more IS6110 bands in an identical pattern, or < 6 bands with identical IS6110 RFLP patterns and spoligotype with the same spacer oligonucleotides. Residential and health care centers addresses were georeferenced. We used a Jeep hand GPS. The coordinates were transferred from the GPS files to ArcGIS using ArcMap 9.3. We evaluated global spatial aggregation of patients in IS6110-RFLP/ spoligotype clusters using global Moran´s I. Since global distribution was not random, we evaluated “hotspots” using Getis-Ord Gi* statistic. Using bivariate and multivariate analysis we analyzed sociodemographic, behavioral, clinic and bacteriological conditions associated with “hotspots”. We used STATA® v13.1 for all statistical analysis. Results From 1995 to 2010, 1,370 patients >20 years were diagnosed with pulmonary TB; 33% had DM. The proportion of isolates that were genotyped was 80.7% (n = 1105), of which 31% (n = 342) were grouped in 91 genotype clusters with 2 to 23 patients each; 65.9% of total clusters were small (2 members) involving 35.08% of patients. Twenty three (22.7) percent of cases were classified as recent transmission. Moran`s I indicated that distribution of patients in IS6110-RFLP/spoligotype clusters was not random (Moran`s I = 0.035468, Z value = 7.0, p = 0.00). Local spatial analysis showed statistically significant spatial aggregation of patients in IS6110-RFLP/spoligotype clusters identifying “hotspots” and “coldspots”. GI* statistic showed that the hotspot for spatial clustering was located in Camerino Z. Mendoza municipality; 14.6% (50/342) of patients in genotype clusters were located in a hotspot; of these, 60% (30/50) lived with DM. Using logistic regression the statistically significant variables associated with hotspots were: DM [adjusted Odds Ratio (aOR) 7.04, 95% Confidence interval (CI) 3.03–16.38] and attending the health center in Camerino Z. Mendoza (aOR18.04, 95% CI 7.35–44.28). Conclusions The combination of molecular and epidemiological information with geospatial data allowed us to identify the concurrence of molecular clustering and spatial aggregation of patients with DM and TB. This information may be highly useful for TB control programs.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Norma Téllez-Vazquez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Sergio Canizales-Quintero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Norma Mongua-Rodríguez
- Doctorado en Geografía, Universidad Nacional Autónoma de México, Ciudad de México, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- * E-mail:
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Xia LL, Li SF, Shao K, Zhang X, Huang S. The correlation between CT features and glycosylated hemoglobin level in patients with T2DM complicated with primary pulmonary tuberculosis. Infect Drug Resist 2018; 11:187-193. [PMID: 29430189 PMCID: PMC5796470 DOI: 10.2147/idr.s146741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To investigate the correlation between computed tomography (CT) features and glycosylated hemoglobin (HbAlc) levels in patients with type 2 diabetes mellitus (T2DM) complicated with primary pulmonary tuberculosis (PTB). One hundred and eighty untreated PTB patients complicated with T2DM were selected. Based on the HbAlc level, the patients were divided into three groups: HbAlc level <7% (Group I: 32 patients), 7%–9% (Group II: 48 patients), and >9% (Group III: 100 patients). The changes of CT manifestations and HbAlc were analyzed after TB and T2DM treatment. In the three groups, the detection rate of large segmented leafy shadow was 50%, 56.2%, and 87%; the air bronchogram sign detection rate was 40.6%, 47.9%, and 77%; the discovery rate of mouth-eaten cavity was 31.2%, 45.8%, and 65%; thick wall cavity detection rate was 25%, 31.2%, and 52%; the rate of multiple cavities was 34.3%, 50%, and 73%; and bronchial TB was found in 33.3%, 21.8%, and 46%, respectively. The detection rates of lesions in Group III were significantly higher than in Group II and Group I (p<0.05), and this increase was significant (p<0.05). After treatment, the HbAlc level reached control target (<7%) among all three groups and CT absorption improvement rates were 100%, 72.9%, and 56% respectively. The therapeutic efficacy of group I was better than group II (p<0.01), and the treatment efficacy of group II was better than group III (p<0.05). CT manifestations of T2DM complicated with PTB were closely related to HbAlc level. The effect is better when HbAlc level <7%. HbAlc level effectively reflects the severity and therapeutic effect to a certain extent. CT scan can provide some important information for clinical imaging. The above two examinations can guide clinicians to formulate the appropriate diagnosis and treatment in a timely manner.
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Affiliation(s)
- Li-Li Xia
- Department of Endocrinology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Su-Fen Li
- Department of Neurology, Huai'an Second People's Hospital and The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, People's Republic of China
| | - Kan Shao
- Department of Endocrinology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xin Zhang
- Department of Radiology, The Fourth People's Hospital of Huai'an, Huai'an, People's Republic of China
| | - Shan Huang
- Department of Endocrinology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Tagliani E, Hassan MO, Waberi Y, De Filippo MR, Falzon D, Dean A, Zignol M, Supply P, Abdoulkader MA, Hassangue H, Cirillo DM. Culture and Next-generation sequencing-based drug susceptibility testing unveil high levels of drug-resistant-TB in Djibouti: results from the first national survey. Sci Rep 2017; 7:17672. [PMID: 29247181 PMCID: PMC5732159 DOI: 10.1038/s41598-017-17705-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/29/2017] [Indexed: 01/15/2023] Open
Abstract
Djibouti is a small country in the Horn of Africa with a high TB incidence (378/100,000 in 2015). Multidrug-resistant TB (MDR-TB) and resistance to second-line agents have been previously identified in the country but the extent of the problem has yet to be quantified. A national survey was conducted to estimate the proportion of MDR-TB among a representative sample of TB patients. Sputum was tested using XpertMTB/RIF and samples positive for MTB and resistant to rifampicin underwent first line phenotypic susceptibility testing. The TB supranational reference laboratory in Milan, Italy, undertook external quality assurance, genotypic testing based on whole genome and targeted-deep sequencing and phylogenetic studies. 301 new and 66 previously treated TB cases were enrolled. MDR-TB was detected in 34 patients: 4.7% of new and 31% of previously treated cases. Resistance to pyrazinamide, aminoglycosides and capreomycin was detected in 68%, 18% and 29% of MDR-TB strains respectively, while resistance to fluoroquinolones was not detected. Cluster analysis identified transmission of MDR-TB as a critical factor fostering drug resistance in the country. Levels of MDR-TB in Djibouti are among the highest on the African continent. High prevalence of resistance to pyrazinamide and second-line injectable agents have important implications for treatment regimens.
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Affiliation(s)
- Elisa Tagliani
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | | | - Yacine Waberi
- National TB Reference Laboratory, Djibouti, Djibouti
| | - Maria Rosaria De Filippo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dennis Falzon
- World Health Organization/Global TB Programme, Geneva, Switzerland
| | - Anna Dean
- World Health Organization/Global TB Programme, Geneva, Switzerland
| | - Matteo Zignol
- World Health Organization/Global TB Programme, Geneva, Switzerland
| | | | | | - Hawa Hassangue
- Programme National de Lutte contre la Tuberculose, Djibouti, Djibouti
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Séraphin MN, Doggett R, Johnston L, Zabala J, Gerace AM, Lauzardo M. Association between Mycobacterium tuberculosis lineage and site of disease in Florida, 2009-2015. INFECTION GENETICS AND EVOLUTION 2017; 55:366-371. [PMID: 28993293 DOI: 10.1016/j.meegid.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Mycobacterium tuberculosis is characterized into four global lineages with strong geographical restriction. To date one study in the United States has investigated M. tuberculosis lineage association with tuberculosis (TB) disease presentation (extra-pulmonary versus pulmonary). We update this analysis using recent (2009-2015) data from the State of Florida to measure lineage association with pulmonary TB, the infectious form of the disease. METHODS M. tuberculosis lineage was assigned based on the spacer oligonucleotide typing (spoligotyping) patterns. TB disease site was defined as exclusively pulmonary or extra-pulmonary. We used ORs to measure the association between M. tuberculosis lineages and pulmonary compared to extra-pulmonary TB. The final multivariable model was adjusted for patient socio-demographics, HIV and diabetes status. RESULTS We analyzed 3061 cases, 83.4% were infected with a Euro-American lineage, 8.4% Indo-Oceanic and 8.2% East-Asian lineage. The majority of the cases (86.0%) were exclusively pulmonary. Compared to the Indo-Oceanic lineage, infection with a Euro-American (AOR=1.87, 95% CI: 1.21, 2.91) or an East-Asian (AOR=2.11, 95% CI: 1.27, 3.50) lineage favored pulmonary disease compared to extra-pulmonary. In a sub-analysis among pulmonary cases, strain lineage was not associated with sputum smear positive status, indicating that the observed association with pulmonary disease is independent of host contagiousness. CONCLUSION As an obligate pathogen, M. tuberculosis' fitness is directly correlated to its transmission potential. In this analysis, we show that M. tuberculosis lineage is associated with pulmonary disease presentation. This association may explain the predominance in a region of certain lineages compared to others.
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Affiliation(s)
- Marie Nancy Séraphin
- Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, USA; Emerging Pathogen Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, USA.
| | - Richard Doggett
- Florida Department of Health, Bureau of Public Health Laboratories, 1217 N. Pearl Street, Jacksonville, FL, 32202, USA.
| | - Lori Johnston
- Florida Department of Health, Bureau of Tuberculosis Control, 4052 Bald Cypress Way, Bin A-20, Tallahassee, FL 32399.
| | - Jose Zabala
- Florida Department of Health, Bureau of Tuberculosis Control, 4052 Bald Cypress Way, Bin A-20, Tallahassee, FL 32399.
| | - Alexandra M Gerace
- Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, USA; Emerging Pathogen Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, USA.
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, University of Florida, College of Medicine, 2055 Mowry Road, P.O. Box 103600, Gainesville, FL 32610, USA; Emerging Pathogen Institute, University of Florida, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL 32610, USA.
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RSSDI clinical practice recommendations for diagnosis, prevention, and control of the diabetes mellitus-tuberculosis double burden. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0577-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Blanco-Guillot F, Delgado-Sánchez G, Mongua-Rodríguez N, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Yanes-Lane M, Montero-Campos R, Bobadilla-del-Valle M, Torres-González P, Ponce-de-León A, Sifuentes-Osornio J, Garcia-Garcia L. Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0184675. [PMID: 28902922 PMCID: PMC5597214 DOI: 10.1371/journal.pone.0184675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus. Materials and methods We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words “tuberculosis AND transmission” OR “tuberculosis diabetes mellitus” OR “Mycobacterium tuberculosis molecular epidemiology” OR “RFLP-IS6110” OR “Spoligotyping” OR “MIRU-VNTR”. Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used. Results Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40–1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429). Conclusion There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Lourdes Garcia-Garcia
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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Shin HJ, Kim TO, Oh HJ, Park HY, Chang JS, Ahn S, Kim YI, Lim SC, Kwon YS. Impact of diabetes mellitus on indeterminate results of the QuantiFERON TB Gold In-Tube test: A propensity score matching analysis. PLoS One 2017; 12:e0181887. [PMID: 28732078 PMCID: PMC5521843 DOI: 10.1371/journal.pone.0181887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/07/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The sensitivity of interferon-gamma release assays (IGRAs) in the detection of Mycobacterium tuberculosis infection could be affected by conditions of immune dysregulation. For this reason, diabetes mellitus (DM) may increase the frequency of indeterminate results of IGRAs. However, there have been inconsistent reports of role of DM on indeterminate IGRA results. METHODS We retrospectively reviewed all patients who underwent QuantiFERON-TB Gold In-Tube testing (QFT-GIT) at Chonnam National University Hospital. We collected the clinical and laboratory data of these patients. RESULTS Of all 3,391 subjects, 1,265 (37.3%) had a positive QFT-GIT result, 266 (7.8%) had an indeterminate result, and 1,860 (54.9%) had a negative result. The mean age was 54.8 ± 18.1 years and 55.0% of the patients were male. There were 512 (15.1%) patients with DM. Multivariable analysis revealed that systemic corticosteroid use, tuberculosis, lymphocytopenia, low serum albumin, and high serum C-reactive protein (CRP) levels were significantly associated with indeterminate QFT-GIT results. However, DM was not associated with indeterminate QFT-GIT results (adjusted odds ratio, 0.98; 95% confidence interval, 0.69-1.41; P = 0.939). After propensity score matching, DM was not associated with indeterminate results of QFT-GIT. CONCLUSION In this large cohort study, DM does not affect the incidence of indeterminate results of QFT-GIT.
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Affiliation(s)
- Hong-Joon Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyung-Joo Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ha-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sun Chang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Ahn
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Abstract
The increase in type 2 diabetes mellitus (DM) patients in countries where tuberculosis (TB) is also endemic has led to the reemerging importance of DM as a risk factor for TB. DM causes a 3-fold increase in TB risk and a 2-fold increase in adverse TB treatment outcomes. Given the sheer numbers of DM patients worldwide, there are now more TB patients with TB-DM comorbidity than TB-HIV coinfection. There is an urgent need to implement strategies for TB prevention and control among the millions of DM patients exposed to Mycobacterium tuberculosis. This chapter summarizes the current epidemiological, clinical, and immunological knowledge on TB and DM and their clinical and public health implications. These include the underlying mechanisms for TB risk in DM patients and their clinical and sociodemographic characteristics that distinguish them from TB patients without DM. TB-DM comorbidity is posing a new challenge for integrating the short-term care for TB with the long-term care for DM, particularly in low- and middle-income countries.
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Affiliation(s)
| | - Anoop Misra
- Fortis CDOC Hopsital for Diabetes and Metabolic Diseases
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Ronacher K, van Crevel R, Critchley JA, Bremer AA, Schlesinger LS, Kapur A, Basaraba R, Kornfeld H, Restrepo BI. Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes: Part 2: Underlying Biologic Mechanisms. Chest 2017; 152:174-180. [PMID: 28434937 PMCID: PMC5577357 DOI: 10.1016/j.chest.2017.02.032] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in the re-emerging interaction between type 2 diabetes (DM) and TB, but the underlying biologic mechanisms are poorly understood despite their possible implications in clinical management. Experts in epidemiologic, public health, basic science, and clinical studies recently convened and identified research priorities for elucidating the underlying mechanisms for the co-occurrence of TB and DM. We identified gaps in current knowledge of altered immunity in patients with DM during TB, where most studies suggest an underperforming innate immunity, but exaggerated adaptive immunity to Mycobacterium tuberculosis. Various molecular mechanisms and pathways may underlie these observations in the DM host. These include signaling induced by excess advanced glycation end products and their receptor, higher levels of reactive oxidative species and oxidative stress, epigenetic changes due to chronic hyperglycemia, altered nuclear receptors, and/or differences in cell metabolism (immunometabolism). Studies in humans at different stages of DM (no DM, pre-DM, and DM) or TB (latent or active TB) should be complemented with findings in animal models, which provide the unique opportunity to study early events in the host-pathogen interaction. Such studies could also help identify biomarkers that will complement clinical studies in order to tailor the prevention of TB-DM, or to avoid the adverse TB treatment outcomes that are more likely in these patients. Such studies will also inform new approaches to host-directed therapies.
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Affiliation(s)
- Katharina Ronacher
- Mater Research Institute-University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia; Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research/Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radbourd University Medical Center, Nijmegen, the Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, UK
| | - Andrew A Bremer
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Larry S Schlesinger
- Department of Microbial Infection and Immunity, Ohio State University, Columbus, OH
| | - Anil Kapur
- World Diabetes Foundation, Copenhagen, Denmark
| | - Randall Basaraba
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Blanca I Restrepo
- School of Public Health, University of Texas Health Science Center Houston, Brownsville, TX
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Leal SB, Araújo GSD, Nery JS, Santos CADST, Oliveira MGD, Barreto ML, Pereira SM. Clinical and epidemiological aspects of cases of tuberculosis associated with diabetes in Salvador, Bahia, Brazil. Rev Soc Bras Med Trop 2017; 50:408-412. [DOI: 10.1590/0037-8682-0409-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/03/2017] [Indexed: 05/29/2023] Open
Affiliation(s)
| | | | - Joilda Silva Nery
- Universidade Federal da Bahia, Brazil; Universidade Federal do Vale do São Francisco, Brazil
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Lee MR, Huang YP, Kuo YT, Luo CH, Shih YJ, Shu CC, Wang JY, Ko JC, Yu CJ, Lin HH. Diabetes Mellitus and Latent Tuberculosis Infection: A Systematic Review and Metaanalysis. Clin Infect Dis 2017; 64:719-727. [PMID: 27986673 PMCID: PMC5399944 DOI: 10.1093/cid/ciw836] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/07/2016] [Indexed: 12/11/2022] Open
Abstract
Background Despite the well-documented association between diabetes and active tuberculosis, evidence of the association between diabetes and latent tuberculosis infection (LTBI) remains limited and inconsistent. Methods We included observational studies that applied either the tuberculin skin test or the interferon gamma release assay for diagnosis of LTBI and that provided adjusted effect estimate for the association between diabetes and LTBI. We searched PubMed and EMBASE through 31 January 2016. The risk of bias of included studies was assessed using a quality assessment tool modified from the Newcastle-Ottawa scale. Results Thirteen studies (1 cohort study and 12 cross-sectional studies) were included, involving 38263 participants. The cohort study revealed an increased but nonsignificant risk of LTBI among diabetics (risk ratio, 4.40; 95% confidence interval [CI], 0.50-38.55). For the cross-sectional studies, the pooled odds ratio from the random-effects model was 1.18 (95% CI, 1.06-1.30), with a small statistical heterogeneity across studies (I2, 3.5%). The risk of bias assessment revealed several methodological issues, but the overall direction of biases would reduce the positive causal association between diabetes and LTBI. Conclusions Diabetes was associated with a small but statistically significant risk for LTBI. Findings from this review could be used to inform future cost-effectiveness analysis on the impact of LTBI screening programs among diabetics.
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Affiliation(s)
- Meng-Rui Lee
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Ya-Ping Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Yu-Ting Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taiwan
| | - Chen-Hao Luo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Yun-Ju Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Chin-Chung Shu
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Jen-Chung Ko
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
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Leung CC, Yew WW, Mok TYW, Lau KS, Wong CF, Chau CH, Chan CK, Chang KC, Tam G, Tam CM. Effects of diabetes mellitus on the clinical presentation and treatment response in tuberculosis. Respirology 2017; 22:1225-1232. [PMID: 28244689 DOI: 10.1111/resp.13017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/01/2017] [Accepted: 01/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE With the colliding global epidemics of diabetes mellitus (DM) and tuberculosis (TB), we studied the effects of DM on the presentation of TB and its response to treatment. METHODS Consecutive TB patients from 2006 to 2010 in a territory-wide treatment programme offering 9-month extended treatment for TB patients with DM were examined and followed up prospectively to assess their treatment response. Successful treatment completers were tracked through the TB registry and death registry for relapse, death or till 31 December 2014, whichever was the earliest. RESULTS DM was independently associated with more chest symptoms (adjusted OR (AOR): 1.13) and systemic symptoms (AOR: 1.30) but less with other site-specific symptoms (AOR: 0.58) at TB presentation. There was more frequent pulmonary involvement (AOR: 1.69), with more extensive lung lesion (AOR: 1.25), lung cavity (AOR: 2.00) and positive sputum smear (AOR: 1.83) and culture (AOR: 1.38), but no difference in the proportion of retreatment cases or isoniazid and/or rifampicin resistance. After treatment initiation, there was higher overall incidence (AOR: 1.38) of adverse effects (mainly gastrointestinal symptoms, renal impairment and peripheral neuropathy but less fever and skin hypersensitivity reactions), more smear non-conversion (AOR: 1.59) and culture non-conversion (AOR: 1.40) at 2 months, and lower combined cure/treatment completion rate at 12 months (AOR: 0.79), but no difference in the relapse rate after having successfully completed treatment. CONCLUSION DM adversely affected the clinical presentation and treatment response of TB, but there was no difference in the drug resistance and relapse rates.
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Affiliation(s)
- Chi C Leung
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China
| | - Wing W Yew
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y W Mok
- Respiratory Medical Department, Kowloon Hospital, Hong Kong, China
| | - Kam S Lau
- Respiratory Medical Unit, Ruttonjee Hospital, Hong Kong, China
| | - Chi F Wong
- Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China
| | - Chi H Chau
- Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China
| | - Chi K Chan
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China
| | - Kwok C Chang
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China
| | - Greta Tam
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk M Tam
- Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China
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Tegegne BS, Habtewold TD, Mengesha MM, Burgerhof JGM. Association between diabetes mellitus and multi-drug-resistant tuberculosis: a protocol for a systematic review and meta-analysis. Syst Rev 2017; 6:6. [PMID: 28088237 PMCID: PMC5237566 DOI: 10.1186/s13643-017-0407-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/05/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Multi-drug-resistant tuberculosis (MDR-TB) has emerged as a challenge to global tuberculosis (TB) control and remains a major public health concern in many countries. Diabetes mellitus (DM) is an increasingly recognized comorbidity that can both accelerate TB disease and complicate its treatment. The aim of this study is to summarize available evidence on the association of DM and MDR-TB among TB patients and to provide a pooled estimate of risks. METHODS All studies published in English before October 2016 will be searched using comprehensive search strings through PubMed, EMBASE, Web of Science, and WHO Global Health Library databases which have reported the association of DM and MDR-TB in adults with TB (age > =15). Two authors will independently collect detailed information using structured data abstraction form. The quality of studies will be checked using Newcastle-Ottawa Scale for cohort and case-control studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. Heterogeneity between included studies will be assessed using the I2 statistic. We will check potential publication bias by visual inspection of the funnel plot and Egger's regression test statistic. We will use the random effects model to compute a pooled estimate. DISCUSSION Increases in the burden of non-communicable diseases and aging populations are changing the importance of different risk factors for TB, and the profile of comorbidities and clinical challenges for people with TB. Although classic risk factors and comorbidities such as overcrowding, under-nutrition, silicosis, and HIV infection are crucial to address, chronic conditions like diabetes are important factors that impair host defenses against TB. Thus, undertaking integrated multifaceted approach is remarkably necessary for reducing the burden of DM and successful TB treatment outcome. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016045692 .
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Affiliation(s)
- Balewgizie Sileshi Tegegne
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia. .,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melkamu Merid Mengesha
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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