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Mihuta C, Socaci A, Hogea P, Tudorache E, Mihuta MS, Oancea C. Colliding Challenges: An Analysis of SARS-CoV-2 Infection in Patients with Pulmonary Tuberculosis versus SARS-CoV-2 Infection Alone. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:823. [PMID: 38793006 PMCID: PMC11123355 DOI: 10.3390/medicina60050823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The concurrent occurrence of tuberculosis and COVID-19 coinfection poses significant clinical complexities, warranting a nuanced approach to diagnosis, management, and patient care. Materials and Methods: A retrospective, cross-sectional study was conducted on two groups: one comprising 32 patients with pulmonary TB (PTB) and COVID-19 co-infection, and one including 100 patients with COVID-19 alone. Data was collected from medical records, including patient history, clinical parameters, laboratory, imaging results, and patient outcome. Results: A lower BMI emerges as a significant marker suggesting underlying PTB in patients with SARS-CoV-2 co-infection. Type 2 diabetes mellitus increases the risk of death in PTB-SARS-CoV-2 co-infection. Co-infected patients show lymphocytopenia and higher neutrophil levels, CRP, transaminases, and D-dimer levels. Elevated CRP and ALT levels are linked to increased co-infection likelihood. Certain parameters like SpO2, CRP, ALT, AST, and D-dimer effectively differentiate between co-infected and COVID-19 patients. Platelet-to-lymphocyte ratio is notably higher in co-infected individuals. Lesion severity on imaging is significantly associated with co-infection, highlighting imaging's diagnostic importance. Longer hospital stays are linked to co-infection but not significantly to death risk. Conclusions: Certain clinical and biological factors may serve as potential indicators of PTB co-infection in patients with SARS-CoV-2.
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Affiliation(s)
- Camil Mihuta
- Department of Doctoral Studies, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
| | - Adriana Socaci
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Department of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldis” Western University of Arad, 310025 Arad, Romania
| | - Patricia Hogea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emanuela Tudorache
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Simina Mihuta
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Clinical Hospital for Infectious Diseases and Pneumology “Dr. Victor Babes”, 300041 Timisoara, Romania; (P.H.); (E.T.); (C.O.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Bailey SL, Floyd S, Cheeba-Lengwe M, Maluzi K, Chiwele-Kangololo K, Kaluba-Milimo D, Amofa-Sekyi M, Yudkin JS, Godfrey-Faussett P, Ayles H. The Effect of HIV on the Association of Hyperglycaemia and Active Tuberculosis in Zambia, a Case-Control Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00236-2. [PMID: 38713341 DOI: 10.1007/s44197-024-00236-2] [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: 10/17/2022] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To determine if HIV modifies the association between hyperglycaemia and active tuberculosis in Lusaka, Zambia. METHODS A case-control study among newly-diagnosed adult tuberculosis cases and population controls in three areas of Lusaka. Hyperglycaemia is determined by random blood glucose (RBG) concentration measured at the time of recruitment; active tuberculosis disease by clinical diagnosis, and HIV status by serological result. Multivariable logistic regression is used to explore the primary association and effect modification by HIV. RESULTS The prevalence of RBG concentration ≥ 11.1 mmol/L among 3843 tuberculosis cases was 1.4% and among 6977 controls was 1.5%. Overall, the adjusted odds ratio of active tuberculosis was 1.60 (95% CI 0.91-2.82) comparing those with RBG concentration ≥ 11.1- < 11.1 mmol/L. The corresponding adjusted odds ratio among those with and without HIV was 5.47 (95% CI 1.29-23.21) and 1.17 (95% CI 0.61-2.27) respectively; p-value for effect modification by HIV = 0.042. On subgroup analysis, the adjusted odds ratio of smear/Xpert-positive tuberculosis was 2.97 (95% CI 1.49-5.90) comparing RBG concentration ≥ 11.1- < 11.1 mmol/L. CONCLUSIONS Overall, no evidence of association between hyperglycaemia and active tuberculosis was found, though among those with HIV and/or smear/Xpert-positive tuberculosis there was evidence of association. Differentiation of hyperglycaemia caused by diabetes mellitus and stress-induced hyperglycaemia secondary to tuberculosis infection is important for a better understanding of these findings.
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Affiliation(s)
- Sarah Lou Bailey
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
- Zambart, Lusaka, Zambia.
| | - Sian Floyd
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
| | - Peter Godfrey-Faussett
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [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: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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Bisht MK, Dahiya P, Ghosh S, Mukhopadhyay S. The cause-effect relation of tuberculosis on incidence of diabetes mellitus. Front Cell Infect Microbiol 2023; 13:1134036. [PMID: 37434784 PMCID: PMC10330781 DOI: 10.3389/fcimb.2023.1134036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
Tuberculosis (TB) is one of the oldest human diseases and is one of the major causes of mortality and morbidity across the Globe. Mycobacterium tuberculosis (Mtb), the causal agent of TB is one of the most successful pathogens known to mankind. Malnutrition, smoking, co-infection with other pathogens like human immunodeficiency virus (HIV), or conditions like diabetes further aggravate the tuberculosis pathogenesis. The association between type 2 diabetes mellitus (DM) and tuberculosis is well known and the immune-metabolic changes during diabetes are known to cause increased susceptibility to tuberculosis. Many epidemiological studies suggest the occurrence of hyperglycemia during active TB leading to impaired glucose tolerance and insulin resistance. However, the mechanisms underlying these effects is not well understood. In this review, we have described possible causal factors like inflammation, host metabolic changes triggered by tuberculosis that could contribute to the development of insulin resistance and type 2 diabetes. We have also discussed therapeutic management of type 2 diabetes during TB, which may help in designing future strategies to cope with TB-DM cases.
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Affiliation(s)
- Manoj Kumar Bisht
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
- Regional Centre for Biotechnology, Faridabad, India
| | - Priyanka Dahiya
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
- Regional Centre for Biotechnology, Faridabad, India
| | - Sudip Ghosh
- Molecular Biology Unit, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sangita Mukhopadhyay
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
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Kornfeld H, Procter-Gray E, Kumpatla S, Kane K, Li W, Magee MJ, Babu S, Viswanathan V. Longitudinal trends in glycated hemoglobin during and after tuberculosis treatment. Diabetes Res Clin Pract 2023; 196:110242. [PMID: 36627027 DOI: 10.1016/j.diabres.2023.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
AIMS To investigate the impact of pulmonary TB on glycemic status during and after TB treatment, and associations of glycemic trends with antidiabetic therapy and TB outcomes. METHODS Data from two prospective cohort studies of adults in Chennai, India, with pulmonary TB were combined for this analysis. Participants were classified by baseline hemoglobin A1c (A1C) as having normoglycemia (NG; n = 74), prediabetes (pre-DM; n = 110), or diabetes (DM; n = 244). Repeat A1C measurements were performed at TB treatment months 3 and 6, and then 6 and 12 months after TB treatment completion. RESULTS Median A1C at baseline declined after TB treatment initiation in all groups. No baseline NG or pre-DM participants progressed to DM by end of study, while 16.7% of baseline DM participants shifted to pre-DM or NG levels of A1C. In the baseline DM group, rising A1C after the intensive phase of TB treatment was significantly associated with adverse TB outcomes. CONCLUSIONS Incident TB promotes transient glucose elevation but was not conclusively shown to promote chronic dysglycemia. Rising A1C during and after TB treatment may predict unfavorable treatment response in persons presenting with A1C ≥ 6.5 % at the time of TB diagnosis.
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Affiliation(s)
- Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | | | | | - Kevin Kane
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Wenjun Li
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Matthew J Magee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Subash Babu
- National Institute for Research in Tuberculosis, International Center for Excellence in Research, National Institutes of Health, Chennai, India
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du Bruyn E, Stek C, Daroowala R, Said-Hartley Q, Hsiao M, Schafer G, Goliath RT, Abrahams F, Jackson A, Wasserman S, Allwood BW, Davis AG, Lai RPJ, Coussens AK, Wilkinson KA, de Vries J, Tiffin N, Cerrone M, Ntusi NAB, Riou C, Wilkinson RJ. Effects of tuberculosis and/or HIV-1 infection on COVID-19 presentation and immune response in Africa. Nat Commun 2023; 14:188. [PMID: 36635274 PMCID: PMC9836341 DOI: 10.1038/s41467-022-35689-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Few studies from Africa have described the clinical impact of co-infections on SARS-CoV-2 infection. Here, we investigate the presentation and outcome of SARS-CoV-2 infection in an African setting of high HIV-1 and tuberculosis prevalence by an observational case cohort of SARS-CoV-2 patients. A comparator group of non SARS-CoV-2 participants is included. The study includes 104 adults with SARS-CoV-2 infection of whom 29.8% are HIV-1 co-infected. Two or more co-morbidities are present in 57.7% of participants, including HIV-1 (30%) and active tuberculosis (14%). Amongst patients dually infected by tuberculosis and SARS-CoV-2, clinical features can be typical of either SARS-CoV-2 or tuberculosis: lymphopenia is exacerbated, and some markers of inflammation (D-dimer and ferritin) are further elevated (p < 0.05). Amongst HIV-1 co-infected participants those with low CD4 percentage strata exhibit reduced total, but not neutralising, anti-SARS-CoV-2 antibodies. SARS-CoV-2 specific CD8 T cell responses are present in 35.8% participants overall but undetectable in combined HIV-1 and tuberculosis. Death occurred in 30/104 (29%) of all COVID-19 patients and in 6/15 (40%) of patients with coincident SARS-CoV-2 and tuberculosis. This shows that in a high incidence setting, tuberculosis is a common co-morbidity in patients admitted to hospital with COVID-19. The immune response to SARS-CoV-2 is adversely affected by co-existent HIV-1 and tuberculosis.
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Affiliation(s)
- Elsa du Bruyn
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Cari Stek
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Remi Daroowala
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
| | - Qonita Said-Hartley
- Department of Radiology, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Marvin Hsiao
- Department of Pathology, University of Cape Town, Observatory, 7925, Republic of South Africa
- National Health Laboratory Service, Groote Schuur Complex, Department of Clinical Virology, Observatory, 7925, Cape Town, Republic of South Africa
| | - Georgia Schafer
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Integrated Biomedical Sciences, University of Cape Town, Observatory, 7925, Republic of South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town, South Africa
| | - Rene T Goliath
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Fatima Abrahams
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Amanda Jackson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, Republic of South Africa
| | - Angharad G Davis
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- The Francis Crick Institute, Midland Road, London, NW1 1AT, UK
- Division of Life Sciences, University College London, London, WC1E 6BT, UK
| | - Rachel P-J Lai
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
- The Francis Crick Institute, Midland Road, London, NW1 1AT, UK
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Pathology, University of Cape Town, Observatory, 7925, Republic of South Africa
- The Walter and Eliza Hall Institute of Medical Research, Parkville Victoria, 3052, Australia
| | - Katalin A Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- The Francis Crick Institute, Midland Road, London, NW1 1AT, UK
- Division of Life Sciences, University College London, London, WC1E 6BT, UK
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Nicki Tiffin
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Health Impact Assessment unit, Western Cape Department of Health, Cape Town, Republic of South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Division of Computational Biology, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Maddalena Cerrone
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
- The Francis Crick Institute, Midland Road, London, NW1 1AT, UK
| | - Ntobeko A B Ntusi
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa
| | - Catherine Riou
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa.
- Department of Pathology, University of Cape Town, Observatory, 7925, Republic of South Africa.
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa.
- Department of Medicine, University of Cape Town, Observatory, 7925, Republic of South Africa.
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK.
- The Francis Crick Institute, Midland Road, London, NW1 1AT, UK.
- Division of Life Sciences, University College London, London, WC1E 6BT, UK.
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Kibirige D, Zawedde-Muyanja S, Andia-Biraro I, Olum R, Adakun S, Sekaggya-Wiltshire C, Kimuli I. Diagnostic accuracy of two confirmatory tests for diabetes mellitus in adult Ugandans with recently diagnosed tuberculosis. Ther Adv Infect Dis 2023; 10:20499361231216799. [PMID: 38145193 PMCID: PMC10748612 DOI: 10.1177/20499361231216799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The optimal confirmatory tests for diabetes mellitus (DM) in patients with tuberculosis (TB) vary across populations. This study aimed to evaluate the performance of two confirmatory tests for DM against the oral glucose tolerance test (OGTT) as the reference test in adult Ugandans with recently diagnosed TB. Methods A total of 232 adult participants receiving TB treatment underwent initial screening for DM with random blood glucose (RBG) measurement. Participants with a RBG level ⩾6.1 mmol/l received additional screening with fasting blood glucose (FBG), laboratory-measured glycated haemoglobin (HbA1c) and an OGTT. Using the latter as the gold standard and reference test, we evaluated the diagnostic accuracy of laboratory-measured HbA1c and FBG. Results Of the 232 participants initially screened for DM using RBG measurement, 117 participants (50.4%) had RBG level ⩾6.1 mmol/l and were scheduled to return for additional blood glucose testing. Of these, 75 (64.1%) participants returned for FBG and HbA1c measurements. A diagnosis of DM was made in 32 participants, corresponding to a prevalence of 13.8% [95% CI 9.9-18.9].The areas under the curve (AUC) for FBG and laboratory-measured HbA1c were 0.69 [95% CI 0.47-0.90] and 0.65 [95% CI 0.43-0.87], respectively. The sensitivity and specificity of a FBG level of ⩾7 mmol/l were 57.1% [95% CI 18.4-90.1] and 74.6% [95% CI 62.5-84.5], respectively, whereas the sensitivity and specificity for laboratory-measured HbA1c of ⩾6.5 mmol/l (48 mmol/mol) were 14.3% [95% CI 0.40-57.9] and 95.3% (86.9-99.0%), respectively. Conclusion FBG may be better than laboratory-measured HbA1c in confirming DM in adult Ugandans with recently diagnosed TB. However, because of the small study sample size, larger studies evaluating the diagnostic utility of these diabetes screening tests in adult Ugandans with TB are needed to confirm these findings.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. BOX 14130 Kampala, Entebbe +256, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis Unit, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
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8
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Williams V, Onwuchekwa C, Vos AG, Grobbee DE, Otwombe K, Klipstein-Grobusch K. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981 - 2021. Glob Health Action 2022; 15:2114146. [PMID: 36178364 PMCID: PMC9543146 DOI: 10.1080/16549716.2022.2114146] [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: 11/04/2022] Open
Abstract
BACKGROUND Hyperglycaemia is a risk factor for tuberculosis. Evidence of changes in blood glucose levels during and after tuberculosis treatment is unclear. OBJECTIVE To compile evidence of changes in blood glucose during and after tuberculosis treatment and the effects of elevated blood glucose changes on treatment outcomes in previously normoglycaemic patients. METHODS Original research studies (1980 to 2021) were identified in PubMed, Web of Science, CINAHL and Embase databases. RESULTS Of the 1,277 articles extracted, 14 were included in the final review. All the studies were observational and 50% were prospective. Fasting blood sugar was the most common clinical test (64%), followed by the glycated haemoglobin test and the oral glucose tolerance test (each 50%). Most tests were conducted at baseline and in the third month of treatment. Twelve studies showed that the prevalence of hyperglycaemia in previously normoglycaemic patients decreased from baseline to follow-up and end of treatment. Three studies showed successful treatment outcomes of 64%, 75% and 95%. Patients with hyperglycaemia at baseline were more likely to develop cavitary lung lesions and poor treatment outcomes and had higher post-treatment mortality. There was no difference in outcomes by human immunodeficiency virus (HIV) status. CONCLUSION Elevated blood glucose in normoglycaemic patients receiving treatment for tuberculosis decreased by the end of treatment. Positive HIV status did not affect glucose changes during treatment. Further research is needed to investigate post-treatment morbidity in patients with baseline hyperglycaemia and the effects of HIV on the association between blood glucose and tuberculosis.
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Affiliation(s)
- Victor Williams
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Monitoring and Evaluation Unit, National Tuberculosis Control Programme, Manzini, Eswatini.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kennedy Otwombe
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Baluku JB, Ronald O, Bagasha P, Okello E, Bongomin F. Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis. Sci Rep 2022; 12:16354. [PMID: 36175540 PMCID: PMC9523035 DOI: 10.1038/s41598-022-20833-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
People with tuberculosis (TB) are at risk of major adverse cardiovascular events. We estimated the prevalence of cardiovascular risk (CVR) factors among people with active TB in Africa. This was a systematic review and meta-analysis of studies from Africa. We searched EMBASE, MEDLINE through PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, mRCTs, Clinical trials.gov, and International Clinical Trials Registry Platform from inception to 31st December 2021. Among 110 eligible studies, 79 (238,316 participants) were included in the meta-analysis for smoking, 67 (52,793 participants) for current alcohol use, 30 (31,450 participants) for hazardous alcohol use, 51 (37,879 participants) for diabetes mellitus (DM), 19 (18,211 participants) for hypertension and 18 (13,910 participants) for obesity. The pooled prevalence was 26.0% (95% confidence interval 22.0–29.0) for smoking, 30.0% (25.0–35.0) for any current alcohol use, 21.0% (17.0–26.0) for hazardous alcohol use, 14.0% (9.0–18.0) for hypertension, 7.0% (6.0–9.0) for DM, and 4.0% (2.0–5.0) for obesity. Cost-effective strategies are needed to screen for CVR factors among people with active TB in Africa.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, PO Box 26343, Kampala, Uganda. .,Makerere University Lung Institute, Kampala, Uganda.
| | - Olum Ronald
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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10
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The challenge of tuberculosis diagnosis and management in the era of the COVID-19 pandemic and diabetes mellitus. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-128743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Obels I, Ninsiima S, Critchley JA, Huangfu P. Tuberculosis risk among people with diabetes mellitus in Sub-Saharan Africa: a systematic review. Trop Med Int Health 2022; 27:369-386. [PMID: 35146851 PMCID: PMC9303199 DOI: 10.1111/tmi.13733] [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: 11/28/2022]
Abstract
Objectives People with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association. Methods Medline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743. Results Nine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I2 = 57% to I2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined. Conclusions There is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship.
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Affiliation(s)
- Ilja Obels
- Master's student Biomedical Sciences, Radboud University Nijmegen, The Netherlands
| | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, UK
| | - Peijue Huangfu
- Population Health Research Institute, St George's, University of London, UK
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12
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Ngo MD, Bartlett S, Ronacher K. Diabetes-Associated Susceptibility to Tuberculosis: Contribution of Hyperglycemia vs. Dyslipidemia. Microorganisms 2021; 9:2282. [PMID: 34835407 PMCID: PMC8620310 DOI: 10.3390/microorganisms9112282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes is a major risk factor for tuberculosis (TB). Diabetes increases the risk of the progression from latent tuberculosis infection (LTBI) to active pulmonary TB and TB patients with diabetes are at greater risk of more severe disease and adverse TB treatment outcomes compared to TB patients without co-morbidities. Diabetes is a complex disease, characterised not only by hyperglycemia but also by various forms of dyslipidemia. However, the relative contribution of these underlying metabolic factors to increased susceptibility to TB are poorly understood. This review summarises our current knowledge on the epidemiology and clinical manifestation of TB and diabetes comorbidity. We subsequently dissect the relative contributions of body mass index, hyperglycemia, elevated cholesterol and triglycerides on TB disease severity and treatment outcomes. Lastly, we discuss the impact of selected glucose and cholesterol-lowering treatments frequently used in the management of diabetes on TB treatment outcomes.
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Affiliation(s)
- Minh Dao Ngo
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
| | - Stacey Bartlett
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
| | - Katharina Ronacher
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, QLD 4102, Australia; (M.D.N.); (S.B.)
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
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13
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Wilkinson RJ. Tuberculosis and Type 2 Diabetes Mellitus: An Inflammatory Danger Signal in the Time of Coronavirus Disease 2019. Clin Infect Dis 2021; 72:79-81. [PMID: 32533824 PMCID: PMC7314248 DOI: 10.1093/cid/ciaa747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Robert J Wilkinson
- Francis Crick Institute, London, United Kingdom.,Department of Infectious Diseases, Imperial College, London, United Kingdom.,Wellcome Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, Republic of South Africa
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14
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Menon S, Rossi R, Dusabimana A, Zdraveska N, Bhattacharyya S, Francis J. The epidemiology of tuberculosis-associated hyperglycemia in individuals newly screened for type 2 diabetes mellitus: systematic review and meta-analysis. BMC Infect Dis 2020; 20:937. [PMID: 33297969 PMCID: PMC7724718 DOI: 10.1186/s12879-020-05512-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
Background There is scarce evidence that tuberculosis (TB) can cause diabetes in those not previously known to be diabetic. Whilst the World Health Organization (WHO) recommends screening for Diabetes Mellitus (DM) at the onset of TB treatment, nevertheless, it remains to be elucidated which patients with TB-associated hyperglycemia are at higher risk for developing DM and stand to benefit from a more regular follow-up. This review aims to firstly quantify the reduction of newly detected hyperglycemia burden in TB patients who are on treatment over time; secondly, determine the burden of TB-associated hyperglycemia after follow-up, and thirdly, synthesize literature on risk factors for unresolved TB-associated hyperglycemia in previously undiagnosed individuals. Methods We searched PUBMED, EMBASE, SCOPUS, and Global Health for articles on TB-associated hyperglycemia up to September 30th, 2019. Search terms included Tuberculosis and hyperglycemia/DM, and insulin resistance. We appraised studies, extracted data, and conducted a meta-analysis to assess the change of the burden of hyperglycemia in prospective studies. The review is registered in the PROSPERO database (CRD42019118173). Results Eleven studies were included in the meta-analysis yielding a total of 677 (27,3%) of patients with newly detected hyperglycemia at baseline. The mean quality score of eligible studies using the Newcastle-Ottawa Quality Assessment Scale was 7.1 out of 9 (range 6-9). The pooled unresolved new cases of hyperglycemia at the end of follow up was 50% (95% CI: 36–64%) and the total pooled burden of hyperglycemia at 3–6 months of follow up was 11% (95% CI: 7–16%), with both estimates displaying a high heterogeneity, which remained significant after performing a sub-analysis by DM diagnostic method and 3 months of follow up. As only 2 studies explored risk factors for unresolved hyperglycemia, no meta-analysis was performed on risk factors. Conclusion Our meta-analysis showed that although in half of the patients with newly observed hyperglycemia at baseline, it remained unresolved at a follow-up of 3 to 6 months, the total burden of hyperglycemia is slightly above 10%, 3 months after initiating TB treatment. Studies are warranted to assess whether risk factors including HIV positivity, smoking, and extensive pulmonary TB disease put patients at higher risk for DM. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05512-7.
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Affiliation(s)
- Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Sint Rochusstraat 43, 2000, Antwerp, Belgium.
| | - Rodolfo Rossi
- International Committee of the Red Cross, Geneva, Switzerland
| | | | - Natasha Zdraveska
- Specialized hospital for Geriatric and Palliative medicine, Skopje, Republic of North Macedonia
| | - Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Uttar Pradesh, India
| | - Joel Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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