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Barot A, Vora A, Dobariya O, Parikh V, Rahumath S L, Shah N, Borisagar G. Clinicoradiological Profile of Patients Having Drug-Sensitive Pulmonary Tuberculosis With and Without Diabetes Mellitus in a Tertiary Care Hospital in Ahmedabad, Gujarat, India. Cureus 2024; 16:e58810. [PMID: 38784356 PMCID: PMC11112967 DOI: 10.7759/cureus.58810] [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] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background A significant effect of diabetes mellitus (DM) on the clinical and radiological features of tuberculosis (TB) has been reported. However, conflicting results have also been reported. Hence, a conclusion is yet to be drawn. This study aimed to analyze and compare the clinical and radiological features of drug-sensitive pulmonary TB with DM and without DM. Methodology A comparative, observational study was conducted between August and October 2023. Patients with drug-resistant TB, extrapulmonary TB, those on immunosuppressive drugs, and human immunodeficiency virus-positive individuals were excluded from this study. Pulmonary TB patients with DM were classified as the case group and those without DM were classified as the control group. Demographic details, clinical symptoms, detailed past and family histories of comorbid conditions, laboratory investigations, sputum acid-fast bacilli results, and chest X-ray findings were noted. The diagnosis of TB and grading of sputum smear results were done by following the National Tuberculosis Elimination Program guidelines. Results A total of 40 patients, 20 (50%) cases and 20 (50%) controls, were enrolled in this study. Clinical symptoms were almost similar in both groups except for dyspnea (80% vs. 40%) and hemoptysis (75% vs. 35%), which were significantly predominant in the case group. Lower zone involvement in chest X-ray was significantly (p = 0.0079) more in the case group (75%) compared to the control group (40%). Cavitary lesions were also significantly higher in the TB with DM group (p = 0.031). Bilateral lesions and multiple zone involvement were also more common in the case group, although no statistically significant difference was seen. Additionally, the hematological parameters of the two groups differed; however, the findings were not statistically significant. Conclusions Based on our findings, we recommend screening all TB patients for DM. Similarly, all high-risk DM patients should be screened for TB for early diagnosis and management, thereby reducing morbidity and mortality. Physicians should be aware that people with DM may present with pulmonary TB in an atypical manner.
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Affiliation(s)
- Anuj Barot
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Asmi Vora
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Om Dobariya
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Vraj Parikh
- Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Loolu Rahumath S
- Respiratory Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Nalin Shah
- Respiratory Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
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Turkar A, Babalik A, Feyzullahoglu G. Comparison of Computed Tomography Findings in Lung Tuberculosis in Diabetic and Nondiabetic Patients. Int J Mycobacteriol 2024; 13:40-46. [PMID: 38771278 DOI: 10.4103/ijmy.ijmy_207_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/16/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is one of the leading infectious causes of mortality globally. The purpose of this research is to examine the clinical and radiological characteristics of patients with TB and diabetes. METHODS The research comprised 276 TB patients, 52 of whom were diabetic and 224 of whom were not. During the evaluation of the patients' clinical histories, age, gender, diagnostic indicator, and whether or not they had undergone prior treatment were questioned, as were the requirement of inpatient treatment and the existence of drug resistance. Radiographically, they were questioned in terms of bilateral-unilateral extent, percentage of parenchymal involvement, cavitation, tree-in-bud appearance, the presence of ground glass, consolidation, miliary involvement, sequela fibrotic changes, parenchymal calcification, mediastinal lymphadenopathy, pleural effusion, and pleural calcification. In addition, segmenting was used to assess involvement in the affected lobes. RESULTS When we look at the results of 276 patients, 182 males and 94 females, the mean age is 46.01 ± 17.83. Diabetes and TB coexistence are more prevalent in male individuals (P = 0.029). Smear positivity and the need for inpatient treatment were found to be higher in the clinical features of diabetic patients (P = 0.05 and P = 0.01, respectively). Radiologically, diabetes individuals are more likely to have larger mediastinal lymph nodes (P = 0.032). CONCLUSION In the coexistence of both TB and diabetes, there are variations in radiological findings, complexity in treatment response, and patient management.
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Affiliation(s)
- Ayla Turkar
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Aylin Babalik
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gorkem Feyzullahoglu
- Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Jung MK, Lee SY, Ko JM, Im SA. The Effect of Diabetes Control Status on CT Findings in Pulmonary Tuberculosis: Emphasis on Bronchial Erosive Changes. J Clin Med 2023; 12:4725. [PMID: 37510840 PMCID: PMC10380713 DOI: 10.3390/jcm12144725] [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: 06/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE Studies on the effect of diabetes mellitus (DM) on the radiologic findings of pulmonary tuberculosis (PTB) have reported inconsistent results. These findings may have been influenced by the glycemic control status of the patients studied. To our knowledge, no recent data have described the effect of the DM control status on CT findings in PTB in terms of medium-sized airway involvement that is visualized as bronchial erosion on CT. The aim of this present study was to determine whether the DM control status influenced radiological manifestations in patients with PTB, with an emphasis on bronchial erosive changes. METHODS We conducted a retrospective single-center study on patients who were newly diagnosed with PTB. A total of 426 consecutive patients with PTB who underwent CT scans at the time of diagnosis from 1 January 2017 to 31 March 2020 were included in this study. The included patients were categorized as having no DM (non-DM), controlled DM, or uncontrolled DM. The patient medical charts, microbiology study results, and pulmonary changes on the CT scans were analyzed. RESULTS Among 426 patients with PTB who underwent CT scans at the time of diagnosis, 91 were excluded either due to undetermined hemoglobin A1C (HbA1C) levels (n = 25) or concomitant pulmonary diseases (n = 66) that would make the analysis of the pulmonary changes on CT scans difficult. Finally, 335 patients were included in this study (224 men and 111 women; mean age, 59 years; range, 16-95 years). Among the 335 patients, 82 (24.5%) had DM and 52 of those (63.4%) had an uncontrolled status. The frequency of cavitation (43% vs. 23% vs. 79%, p < 0.001) and bronchial erosion (44% vs. 30% vs. 73%, p < 0.001) was significantly different between the three groups. The uncontrolled DM group showed a high frequency of cavitation and bronchial erosion compared to the non-DM (cavitation, p < 0.001 and bronchial erosion, p < 0.001) and controlled DM groups (p < 0.001 and p < 0.001). However, the frequency of cavitation and bronchial erosion in the controlled DM group was not different compared to the non-DM group. CONCLUSION The glycemic status (HbA1C ≥ 7.0), not the presence of DM, influenced the radiologic manifestations of PTB, especially in terms of medium-sized bronchial involvement, appearing as bronchial erosive changes and the feeding bronchus sign on chest CT scans. This difference in the uncontrolled DM group was likely to contribute to the higher frequency of cavitation.
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Affiliation(s)
- Min Kyung Jung
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang Young Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jeong Min Ko
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Soo-Ah Im
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Ren Y, Ren H, Tian Q, Li X, Liu Y. The relationship between computed tomography appearance of pulmonary tuberculosis and blood glucose levels in 763 diabetes mellitus patients with pulmonary tuberculosis: a comparative study. Endocrine 2022; 76:584-592. [PMID: 35332512 PMCID: PMC9156482 DOI: 10.1007/s12020-022-03033-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/02/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Glucose tolerance is often impaired in pulmonary tuberculosis (TB) patients. We aimed to explore the relationship between computed tomography (CT) findings of TB and blood glucose levels in diabetes mellitus (DM) patients. METHODS 763 diabetes mellitus patients with pulmonary tuberculosis (DMTB) from March 2015 to March 2018 were selected and their clinical data were retrospectively evaluated. CT appearance of DMTB was reviewed and compared according to blood glucose levels and CT scores. TB scores were calculated according to the combination of typical and atypical CT appearance. The relationship between blood glucose levels and CT scores was analyzed via Pearson correlation coefficient. RESULTS TB lesions mainly occurred in the left lung and the lower lobes in the DMTB patients. Nodules and cavities are the main typical complications in these DMTB patients, and especially the number and size of cavities predominantly contribute to CT scan scores. The size of cavities (diameters (cm), median (95% CI of median)) was 0.72 (0.66-0.77), 1.20 (1.09-1.28), and 3.45 (2.92-3.94) from the low-, middle- and high-CT-score groups, respectively. The patients with high CT scores had a higher level of fasting plasma glucose (mean 13.48 mM, 95% CI of median 12.56-14.44 mM) than the patients in the low-CT-score (mean 8.73 mM, 95% CI of median 8.49-9.36 mM) and middle-CT-score groups (mean 10.16 mM, 95% CI of median 9.89-10.49 mM) (P < 0.0001). CT scores have a consistent relationship with the levels of blood glucose (rho = 0.60, P < 0.0001). CONCLUSIONS CT appearance stands for the severity of tuberculosis and is closely associated with blood glucose levels in diabetic TB patients.
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Affiliation(s)
- Yan Ren
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China.
| | - Hongmei Ren
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Qian Tian
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Xue Li
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Yuxi Liu
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
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Abreu RGD, Rolim LS, Sousa AIAD, Oliveira MRFD. Tuberculosis and diabetes: association with sociodemographic characteristics and diagnosis and treatment of tuberculosis. Brazil, 2007-2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200009. [PMID: 32130398 DOI: 10.1590/1980-549720200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/12/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tuberculosis and diabetes comorbidity remains a challenge for global public health. OBJECTIVE To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. METHODS This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. RESULTS We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). CONCLUSION The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.
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Affiliation(s)
| | - Lúcia Santana Rolim
- Ministério da Saúde, Secretaria de Vigilância Sanitária - Brasília (DF), Brasil
| | | | - Maria Regina Fernandes de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical - Brasília (DF), Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Conselho Nacional de Desenvolvimento Científico e Tecnológico - Porto Alegre (UF), Brasil
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Zafar MI, Chen LL, Xiaofeng Y, Gao F. Impact of Diabetes Mellitus on Radiological Presentation of Pulmonary Tuberculosis in Otherwise Non-Immunocompromised Patients: A Systematic Review. Curr Med Imaging 2020; 15:543-554. [PMID: 32008562 DOI: 10.2174/1573405614666180806124416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/04/2018] [Accepted: 07/25/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies on the influence of diabetes mellitus on the radiological presentation of pulmonary tuberculosis performed so far yielded inconsistent results. We aimed to summarize the relevant evidence on this topic systematically. METHODS We systematically searched PubMed/MEDLINE (1980-2016) and the references of related articles (English-language reports) for observational studies that compared the radiological presentation of pulmonary tuberculosis in diabetes and non-diabetes patients. RESULTS A total of fifteen studies that enrolled 2,020 diabetic patients and 5,280 controls were included in this systematic review. None of the included studies showed any significant difference in the upper lobe involvement and or in bilateral disease between diabetes and non-diabetes patients. However, lower lung field cavitary disease was found to be more frequent (relative risks ranging from 2.76, 95% CI 2.28-3.35 to 4.47, 95% CI 2.62-7.62) in patients with poor glycemic control (HbA1C >9%). Similarly, a significantly higher proportion of cavitary disease in diabetes patients was reported by 7 out of 15 studies, the meta-analysis of cavities of any size/site also showed the significantly higher risk of cavitary disease in diabetes patients (p-value = 0.0008). Three studies stratified the presence of cavities by diabetes control status, finding a higher proportion of cavities in uncontrolled diabetic patients (relative risks ranging from 1.85, 95%CI 1.34-2.55 to 3.59, 95%CI 2.53-5.11). One out of four studies found a significantly higher proportion of nodular infiltrations in diabetes versus non-diabetes patients. CONCLUSION While there is no difference in localization of lung lesions between patients with diabetes and non-diabetes, our review found that the risk of cavitary disease is relatively higher in diabetes patients. It is essential for researchers to unify the criteria for diabetes diagnosis, patient selection, and radiographic severity and stratify the results by the potentially confounding factors.
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Affiliation(s)
- Mohammad Ishraq Zafar
- Department of Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, China
| | - Lu-Lu Chen
- Department of Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, China
| | - Ye Xiaofeng
- Department of Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, China
| | - Feng Gao
- Department of Endocrinology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, China
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Nakao M, Muramatsu H, Arakawa S, Sakai Y, Suzuki Y, Fujita K, Sato H. Immunonutritional status and pulmonary cavitation in patients with tuberculosis: A revisit with an assessment of neutrophil/lymphocyte ratio. Respir Investig 2018; 57:60-66. [PMID: 30528689 DOI: 10.1016/j.resinv.2018.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several reports have described the importance of immunological and nutritional factors in the morbidity and/or mortality of patients with tuberculosis. The aim of this study was to evaluate the association between pulmonary cavitation and immunonutritional status, assessed by parameters such as neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI), in patients with pulmonary tuberculosis. METHODS We retrospectively analyzed the data of 137 patients with culture-positive active pulmonary tuberculosis without bacterial pneumonia diagnosed at Kainan Hospital between April 2008 and March 2016. The associations between the levels of serum albumin, lymphocytes, NLR, PNI, platelet to lymphocyte ratio (PLR), and body mass index (BMI) and pulmonary cavitation were evaluated in the patients. RESULTS A total of 83 men and 63 women (median age, 75 years; range, 16-94 years) were included in the study. Sixty-six patients had smoking history; 55 patients had respiratory symptoms, while 44 patients did not have any symptoms. Patient׳s delay, defined as medical examination performed over 60 days after the onset of symptoms was observed in 25 patients. Univariate analysis showed that high NLR (≥ 5), high PLR (≥200), low serum albumin (<3 g/dL), high neutrophil count (≥6000/mm3), and low lymphocyte count (<1000/mm3) were associated with pulmonary cavitation. Multivariate analysis showed that high NLR and low serum albumin were associated with pulmonary cavitation. CONCLUSION Malnutrition and increased severity of inflammation may be associated with pulmonary cavitation in patients with tuberculosis. Further studies are warranted to confirm the findings of the present study.
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Affiliation(s)
- Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan.
| | - Hideki Muramatsu
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Sosuke Arakawa
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Yusuke Sakai
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Yuto Suzuki
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Kohei Fujita
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
| | - Hidefumi Sato
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, 396 Minamihonndenn, Maegasu-cho, Yatomi City, Aichi Prefecture 498-8502, Japan
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Alkabab YM, Enani MA, Indarkiri NY, Heysell SK. Performance of computed tomography versus chest radiography in patients with pulmonary tuberculosis with and without diabetes at a tertiary hospital in Riyadh, Saudi Arabia. Infect Drug Resist 2018; 11:37-43. [PMID: 29379307 PMCID: PMC5757200 DOI: 10.2147/idr.s151844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Prior research suggests that diabetes mellitus (DM) is associated with increasing risk for developing cavitary lung disease in patients with pulmonary tuberculosis (TB). Additionally, chest computed tomography (CT) scan may be more sensitive than chest X-ray in detecting cavitary disease in such patients. The aim of this study was to compare the performance of chest CT to chest X-ray in detecting cavitary lung disease and to compare the frequency of cavities between TB patients with DM and without DM. Patients and methods We conducted a retrospective cohort study at King Fahad Medical City, Riyadh, Saudi Arabia, from January 2004 to December 2015. We included patients aged 18 years and older with a positive sputum culture for Mycobacterium tuberculosis, and their medical charts were reviewed from admission to discharge. Results Of the 133 patients who met the inclusion criteria, 38 (28.6%) patients were known to have DM and were compared with 95 (71.4%) patients without DM. DM patients with glycated hemoglobin (HbA1c) >6.5% had significantly more cavitary lesions when compared to all patients (with or without DM) with HbA1c <6.4% and/or random blood sugar <200 mg/dL. Furthermore, CT was able to detect lung cavities in 58.8% of the patients who had negative chest X-ray findings for cavities. Conclusion The presence of lung cavities was significantly associated with the presence of DM and levels of HbA1c in patients with pulmonary TB. CT scan in those with normal radiography increased the detection of cavities.
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Affiliation(s)
- Yosra M Alkabab
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Nouf Y Indarkiri
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Scott K Heysell
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Kim J, Lee IJ, Kim JH. CT findings of pulmonary tuberculosis and tuberculous pleurisy in diabetes mellitus patients. Diagn Interv Radiol 2017; 23:112-117. [PMID: 28185999 DOI: 10.5152/dir.2016.16157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to assess computed tomography (CT) findings of pulmonary tuberculosis (TB) and TB pleurisy in diabetes mellitus (DM) patients and to evaluate the effect of duration of DM on radiologic findings of pulmonary TB and TB pleurisy. METHODS Ninety-three consecutive patients diagnosed as active pulmonary TB with underlying DM were enrolled in our study. As a control group, 100 pulmonary TB patients without DM were randomly selected. TB patients with DM were subdivided into two subgroups depending on diabetes duration of ≥10 years or <10 years. Medical records and CT scans of the patients were retrospectively reviewed and compared. RESULTS Bilateral pulmonary involvement (odds ratio [OR]=2.39, P = 0.003), involvement of all lobes (OR=2.79, P = 0.013), and lymph node enlargement (OR=1.98, P = 0.022) were significantly more frequent CT findings among TB patients with DM compared with the controls. There were no statistically significant differences in CT findings of pulmonary TB depending on the duration of DM. CONCLUSION Bilateral pulmonary involvement, involvement of all lobes, and lymph node enlargement are significantly more common CT findings in TB patients with underlying DM than in patients without DM. Familiarity with the CT findings may be helpful to suggest prompt diagnosis of pulmonary TB in DM patients.
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Affiliation(s)
- Jihyun Kim
- Department of Radiology, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea.
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Huang LK, Wang HH, Lai YC, Chang SC. The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients. PLoS One 2017. [PMID: 28628646 PMCID: PMC5476287 DOI: 10.1371/journal.pone.0179750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Setting Diabetes mellitus (DM) may increase risk of pulmonary tuberculosis (PTB) and influence its radiological manifestations. Objective To evaluate the impact of glycemic status on radiological findings of PTB in diabetic patients. Methods Between January 2010 and December 2015, chest radiographs (CXRs) in consecutive 214 DM patients with culture-proved PTB and 123 available thoracic computed tomography (CT) scans were enrolled. An equal number of non-DM patients with similar demographics was included as the control group. Glycemic status was assessed by glycosylated hemoglobin (HbA1c), and a cutoff of 8% was used to further investigate radiological features of diabetic PTB. Two radiologists and one pulmonologist reviewed the chest images independently. Results Compared with non-DM patients, primary PTB pattern and extensive disease on CXRs as well as primary PTB pattern, large non-cavitary nodule, more than one cavity in a single lesion, unusual location, and all lobe involvement of lesions on thoracic CT scans were more common in DM patients. Furthermore, diabetics with HbA1c > 8% were more likely to exhibit unusual findings (P < 0.001), far advanced extensive lesions (P < 0.001) on CXRs, lymphadenopathy (P = 0.028), more than one cavity in a single lesion (P < 0.001) and all lobe involvement (P = 0.041) on thoracic CT scans. Conclusions Glycemic status influenced radiological manifestations of diabetic PTB. Given an increased risk of atypical radiological presentations of PTB in DM patients, physicians should be alert and pay more attention to those with poor glycemic control.
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Affiliation(s)
- Li-Kuo Huang
- Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsueh-Han Wang
- Department of Radiology, National Yang-Ming University Hospital, Yi-Lan, Taiwan
| | - Yi-Chun Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Division of Chest Medicine, National Yang-Ming University Hospital, Yi-Lan, Taiwan
| | - Shi-Chuan Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Clinicoradiological Profile of Lower Lung Field Tuberculosis Cases among Young Adult and Elderly People in a Teaching Hospital of Madhya Pradesh, India. J Trop Med 2015; 2015:230720. [PMID: 26379713 PMCID: PMC4562182 DOI: 10.1155/2015/230720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/30/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. To study the clinical and radiological features of lower lung field tuberculosis (LLFTB) in relation to the patients of nonlower lung field tuberculosis (non-LLFTB). Material and Methods. All the patients of lower lung field tuberculosis defined by the lesions below an arbitrary line across the hila in their chest X-rays were included in the study. Their sputum for acid fast bacilli, HIV, blood sugar, and other relevant investigations were performed. Results. The total of 2136 cases of pulmonary tuberculosis was studied. Among them 215 (10%) cases of patients were diagnosed as the case of lower lung field tuberculosis. Females (62%) were more commonly affected. Most common clinical feature in non-LLFTB was cough (69%) followed by fever (65%), chest pain (54.7%), and weight loss (54.4%). Chest X-ray showed predominance of right side (60.9%) in cases of LLFTB. The relative risk of having the LLFTB in diabetes patients, HIV seropositive patients, end stage renal disease patients, and patients on corticosteroid therapy was high. Conclusion. Lower lung field tuberculosis is not an uncommon entity. It is more common in diabetes, HIV positive, end stage renal disease, and corticosteroid treated patients. Clinical and radiological features are different from upper lobe tuberculosis patients.
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Sharma P, Visnegarwala F, Tripathi V. Burgeoning double burden of tuberculosis and diabetes in India: Magnitude of the problem – Strategies and solutions. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2014. [DOI: 10.1016/j.cegh.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Choo JY, Lee KY, Kim MY, Kang EY, Oh YW, Lee SH, Seo BK, Je BK. Pulmonary Tuberculosis Confirmed by Percutaneous Transthoracic Needle Biopsy: Analysis of CT Findings and Review of Correlations with Underlying Lung Disease. Balkan Med J 2014; 31:208-13. [PMID: 25625018 DOI: 10.5152/balkanmedj.2014.13187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/23/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (TB) can produce unusual radiographic findings. Further, negative sputum and bronchoscopic results are common. Early diagnosis is equally as significant as treatment in the reduction of morbidity and mortality associated with pulmonary TB. AIMS The aim of this study was to assess computed tomography (CT) findings of pulmonary TB, confirmed via percutaneous transthoracic needle biopsy (PTNB), and to correlate these findings with coexisting, underlying, lung diseases if present. STUDY DESIGN Cross sectional study. METHODS We selected eighty-four patients who were diagnosed with pulmonary TB by way of PTNB. Initially, acid-fast bacilli smear test results from these patients were negative. CT findings were reviewed to detect the presence of parenchymal abnormalities as follows: nodule(s) (<3 cm in diameter), mass (any masses ≥3 cm), daughter nodules, air-space consolidation, cavitation, calcification, lymphadenopathy, mediastinal lymphadenopathy, and associated lung parenchymal disease. RESULTS The CT findings of pulmonary TB confirmed by PTNB included nodules in 44 of 84 (52.4%) cases; 15 of these 44 cases (34.1%) had daughter nodules. The second most common finding was masses in 24 cases (28.6%), nine of which also had daughter nodules. 16 cases (19.0%) displayed nonsegmental consolidation. Of these 16 cases, four had coexisting usual interstitial pneumonia; four others had emphysema. Two patients with a mass had underlying pneumoconiosis. CONCLUSION Nodules or a mass mimicking lung cancer were the most common findings on CT scans in patients with pulmonary TB, confirmed via PTNB. The second most common finding was airspace consolidation. Therefore, PNTB is useful for the accurate diagnosis of pulmonary TB in the following cases: airspace consolidation or mass associated with underlying usual interstitial pneumonia, emphysema mimicking lung malignancy or cases of bacterial pneumonia.
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Affiliation(s)
- Ji Young Choo
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Mi-Young Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Yu Whan Oh
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Bo Kyung Seo
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
| | - Bo Kyung Je
- Department of Radiology, Korea University College of Medicine, Seoul, South Korea
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Nakamura A, Hagiwara E, Hamai J, Taguri M, Terauchi Y. Impact of underlying diabetes and presence of lung cavities on treatment outcomes in patients with pulmonary tuberculosis. Diabet Med 2014; 31:707-13. [PMID: 24547904 DOI: 10.1111/dme.12414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/19/2013] [Accepted: 12/17/2013] [Indexed: 01/02/2023]
Abstract
AIMS We investigated the effects of diabetes and the presence of lung cavities on treatment outcomes in patients with pulmonary tuberculosis. METHODS We conducted a retrospective review of the clinical records of all consecutive patients admitted to the Kanagawa Cardiovascular and Respiratory Centre with the diagnosis of pulmonary tuberculosis. The study outcomes examined were time to sputum culture conversion and percentage of patients with sputum culture conversion by the time 2 months of treatment, and these outcomes were compared between patients with and without diabetes. RESULTS Of the 260 patients enrolled in the study, 69 were diagnosed as having diabetes mellitus, while the remaining 191 did not have diabetes. The percentage of patients with cavities was higher in the patients with diabetes (71.0%) than in those without (45.5%; P = 0.0003). The time to sputum culture conversion was significantly longer in the patients with diabetes than in those without (P = 0.0005), and the percentage of patients with a positive sputum culture at 2 months was higher in the patients with diabetes (43.5%) than in those without (18.8%; P = 0.0001). Multivariate analyses revealed that the presence/absence of lung cavities was a more important determinant of treatment outcomes than the presence/absence of diabetes. CONCLUSIONS The presence of lung cavities was found to be a more important determinant of the treatment outcomes than that of diabetes per se in patients with pulmonary tuberculosis.
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Affiliation(s)
- A Nakamura
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Chiang CY, Lee JJ, Chien ST, Enarson DA, Chang YC, Chen YT, Hu TY, Lin CB, Suk CW, Tao JM, Bai KJ. Glycemic control and radiographic manifestations of tuberculosis in diabetic patients. PLoS One 2014; 9:e93397. [PMID: 24699457 PMCID: PMC3974751 DOI: 10.1371/journal.pone.0093397] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB. METHODS Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005-2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients' diabetic status. Films with any discordant reading were read by a third reader. RESULTS 1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46-1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%-9%, and 1.62 (95% CI 1.12-2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46-1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20-2.84) for A1C 7%-9%, and 3.71 (95% CI 2.64-5.22) for A1C>9%, relative to patients without DM. CONCLUSIONS Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.
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Affiliation(s)
- Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Jyh Lee
- Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Shun-Tien Chien
- Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan
| | - Donald A. Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - You-Cheng Chang
- Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan
| | - Yi-Ting Chen
- Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Ting-Yu Hu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Chi-Won Suk
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-Ming Tao
- Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan
| | - Kuan-Jen Bai
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR. Diabetes mellitus and tuberculosis facts and controversies. J Diabetes Metab Disord 2013; 12:58. [PMID: 24360398 PMCID: PMC7962555 DOI: 10.1186/2251-6581-12-58] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/17/2013] [Indexed: 02/01/2023]
Abstract
Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues. A bidirectional association between them has been demonstrated by many researchers. The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of diabetes mellitus is increasing. The association between diabetes and tuberculosis may be the next challenge for global tuberculosis control worldwide. Proper planning and collaboration are necessary to reduce the dual burden of diabetes and TB. One model similar to the TB-HIV program for prevention, screening and treatment of both diseases can be the best approach. In this paper, we review existing data and discuss the matters of controversy that would be helpful for determining research priorities in different countries.
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Affiliation(s)
| | | | | | | | - Mohammad Reza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Duangrithi D, Thanachartwet V, Desakorn V, Jitruckthai P, Phojanamongkolkij K, Rienthong S, Chuchottaworn C, Pitisuttithum P. Impact of diabetes mellitus on clinical parameters and treatment outcomes of newly diagnosed pulmonary tuberculosis patients in Thailand. Int J Clin Pract 2013; 67:1199-209. [PMID: 23750554 PMCID: PMC4232236 DOI: 10.1111/ijcp.12215] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/19/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To assess the clinical and laboratory parameters, response to therapy and development of antituberculosis (TB) drug resistance in pulmonary TB (PTB) patients with diabetes mellitus (DM) and without DM. METHODS Using a prospective design, 227 of 310 new cases of culture-positive PTB diagnosed at the Queen Savang Vadhana Memorial Hospital and the Chonburi Hospital between April 2010 and July 2012 that met the study criteria were selected. Data regarding clinical and laboratory parameters, drug susceptibility and treatment outcomes were compared between PTB patients with DM and those without DM. To control for age, the patients were stratified into two age groups (< 50 and ≥ 50 years) and their data were analysed. RESULTS Of the 227 patients, 37 (16.3%) had DM, of which 26 (70.3%) had been diagnosed with DM prior to PTB diagnosis and 11 (29.7%) had developed DM at PTB diagnosis. After controlling for age, no significant differences were found between the two groups regarding mycobacterium burden, sputum-culture conversion rate, evidence of multidrug-resistant tuberculosis, frequency of adverse drug events from anti-TB medications, treatment outcomes and relapse rate. The presenting symptoms of anorexia (p = 0.050) and haemoptysis (p = 0.036) were observed significantly more frequently in PTB patients with DM, while the presenting symptom of cough was observed significantly more frequently in PTB patients without DM (p = 0.047). CONCLUSIONS Plasma glucose levels should be monitored in all newly diagnosed PTB patients and a similar treatment regimen should be prescribed to PTB patients with DM and those without DM in high TB-burden countries.
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Affiliation(s)
- D Duangrithi
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Dholakia YN, D'souza DTB, Tolani MP, Chatterjee A, Mistry NF. Chest X-rays and associated clinical parameters in pulmonary tuberculosis cases from the National Tuberculosis Programme, Mumbai. Infect Dis Rep 2012; 4:e10. [PMID: 24470917 PMCID: PMC3892641 DOI: 10.4081/idr.2012.e10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/04/2011] [Accepted: 11/14/2011] [Indexed: 11/28/2022] Open
Abstract
The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of X-rays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.
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Rawat J, Sindhwani G, Biswas D. Effect of age on presentation with diabetes: Comparison of nondiabetic patients with new smear-positive pulmonary tuberculosis patients. Lung India 2011; 28:187-90. [PMID: 21886953 PMCID: PMC3162756 DOI: 10.4103/0970-2113.83975] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Diabetes mellitus (DM) has been reported to modify the presenting features of pulmonary tuberculosis (PTB), but data regarding the effect of diabetes on the presentation of PTB are highly variable. Objective: To determine whether DM alters the demographic, clinical, and radiological manifestations of tuberculosis and whether the effect of diabetes varies with the age group of PTB patients. Materials and Methods : This prospective observational study was conducted on new smear-positive PTB patients with DM (PTB-DM group) and non-diabetic PTB patients (PTB group). Patients of both groups were again divided into six age groups (15–29, 30–39, 40–49, 50–59, 60–69, and >70 rears) to analyze and compare the impact of age on clinicoradiological presentations of PTB. Results: Patients in the PTB-DM group were significantly older (53.34 ± 14.06 year) in comparison to their nondiabetic counterparts (PTB group) (44.35 ± 18.14 year) (P < 0.001). The former group also had a lower male:female ratio, although the difference was not statistically significant (1.16:1 vs. 2.05:1, P = 0.101). Tuberculin positivity was significantly higher in the PTB group, compared with patients in the PTB-DM group (P < 0.004). The proportion of patients with lower lung field involvement (P = 0.003) and cavitations (P = 0.005) was also higher in the former group compared with the latter. Conclusion: Diabetic patients with tuberculosis were relatively older, had lower tuberculin positivity, and higher proportion of lower lung field involvement and cavitation in comparison to nondiabetic patients.
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Affiliation(s)
- Jagdish Rawat
- Department of Pulmonary Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Ruslami R, Aarnoutse RE, Alisjahbana B, van der Ven AJAM, van Crevel R. Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Int Health 2011; 15:1289-99. [PMID: 20955495 DOI: 10.1111/j.1365-3156.2010.02625.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To review the current knowledge about tuberculosis (TB) and diabetes, assessing the implication of the global increase of diabetes for TB control and patient care. METHODS Systematic literature review. RESULTS Using public databases, it can be estimated that 12.6% (95% CI 9.2-17.3%) of new TB cases in the 10 countries with the highest TB burden will be attributable to TB in 2030, a relative increase of 25.5% compared to 2010. Diabetes is associated with a higher age and body weight among patients with TB, but probably not with a specific clinical presentation of TB. Rifampicin hampers glycemic control by increasing the metabolism of most oral antidiabetic drugs, while diabetes patients may have lower concentrations of anti-TB drugs. This might be one factor contributing to higher TB treatment failure rates. CONCLUSIONS The global epidemic of diabetes has implications for control and treatment of TB. Prospective studies are needed to improve prevention, early detection and treatment of concomitant diabetes and TB, especially in developing countries.
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Affiliation(s)
- Rovina Ruslami
- Department of Pharmacology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
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Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. THE LANCET. INFECTIOUS DISEASES 2009; 9:737-46. [PMID: 19926034 PMCID: PMC2945809 DOI: 10.1016/s1473-3099(09)70282-8] [Citation(s) in RCA: 541] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.
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Affiliation(s)
- Kelly E Dooley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
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Abstract
BACKGROUND The aim of the present study was to compare the frequency of pleural tuberculosis in patients with and without diabetes mellitus (DM). METHODS Three hundred consecutive patients who were smear positive for pulmonary tuberculosis or isolated pleural tuberculosis were enrolled in the study. Patients' age and smoking status (pack-years) were recorded. Patients were divided into two groups: those with and without DM. RESULTS All patients enrolled in the study were male. Mean (± SD) patient age was 42.4 ± 15.9 years. Of the 300 patients in the study, 48 had DM. There was no significant difference in the distribution of pulmonary tuberculosis and isolated pleural tuberculosis between patients with and without DM (P > 0.05). However, there was a significant difference in mean pack-years of smoking between patients with pulmonary tuberculosis and those with isolated pleural tuberculosis for all patients; patients with isolated pleural tuberculosis had a significantly lower number of pack-years of smoking (P < 0.05). CONCLUSION Severe pulmonary involvement in DM patients may be due to smoking status.
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Affiliation(s)
- Serpil Ocal
- Department of Chest Diseases, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
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Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff THM, Nelwan RHH, Parwati I, van der Meer JWM, van Crevel R. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis 2007; 45:428-35. [PMID: 17638189 DOI: 10.1086/519841] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 03/24/2007] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB), and with the increasing prevalence of type 2 DM in less developed regions, many patients with TB will have concomitant DM. Presently, little is known about the effect of DM on the clinical presentation and treatment outcome of TB. METHODS In an urban setting in Indonesia, 737 patients with pulmonary TB were screened for DM and were followed up prospectively during TB treatment. Clinical characteristics and outcome were compared between patients with TB who had DM and patients with TB who did not have DM. RESULTS DM was diagnosed in 14.8% of patients with TB and was associated with older age and a greater body weight. On presentation, diabetic patients with TB had more symptoms but had no evidence of more-severe TB. After 2 months, results of sputum microscopic examination was more often positive in diabetic patients (18.1% vs. 10.0%). After 6 months, 22.2% of cultured sputum specimens from diabetic patients were positive for Mycobacterium tuberculosis (adjusted odds ratio, 7.65; P=.004). CONCLUSION DM seems to have a negative effect on the outcome of TB treatment. The underlying mechanisms for the different response to treatment in diabetic patients with TB must be explored. Screening for DM and subsequent glycemic control may improve the outcome of TB treatment.
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Affiliation(s)
- Bachti Alisjahbana
- Internal Medicine, Medical Faculty, Padjadjaran University, Bandung, Indonesia
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Endocrine and Metabolic Manifestations of Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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González Constán E, Franco Serrano J, Domingo Montañana M, Inchaurraga Álvarez I, Blanquer Olivas R, Marín Pardo J. Tomografía computarizada de alta resolución en tuberculosis pulmonar con baciloscopia de esputo negativa. Rev Clin Esp 2003. [DOI: 10.1016/s0014-2565(03)71347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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BOMBARDA SIDNEY, FIGUEIREDO CLÁUDIAMARIA, FUNARI MARCELOBUARQUEDEGUSMÃO, SOARES JÚNIOR JOSÉ, SEISCENTO MÁRCIA, TERRA FILHO MÁRIO. Imagem em tuberculose pulmonar. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0102-35862001000600007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A tuberculose é uma doença de alta incidência e prevalência no Brasil. Sinais sugestivos de atividade ou seqüela da tuberculose podem ser obtidos através dos métodos de imagem. Na radiografia de tórax, a tuberculose pulmonar ativa pode manifestar-se sob a forma de consolidações, cavitações, padrões intersticiais (reticulares/retículo-nodulares), linfonodomegalias hilares ou mediastinais e derrame pleural. Imagens compatíveis com doença ativa, como nódulos centrolobulares de distribuição segmentar, cavidades de paredes espessas, espessamento de parede brônquica ou bronquiolar, bronquiectasias e linfonodomegalias, podem ser observadas pela tomografia computadorizada do tórax; cavidades de paredes finas, bronquiectasias de tração e estrias são imagens sugestivas de seqüela da doença, assim como o enfisema e o aspecto em mosaico do parênquima pulmonar. A cintilografia com o citrato de gálio-67 é um método complementar útil na detecção de processos infecciosos, incluindo a tuberculose, especialmente em pacientes imunossuprimidos. Estudos de inalação e perfusão pulmonar são utilizados na avaliação pré-operatória de pacientes com seqüelas de tuberculose ou tuberculose multirresistente. A tomografia por emissão de pósitrons utilizando a deoxiglicose marcada com o flúor-18 permite a detecção do processo inflamatório que ocorre na fase ativa da tuberculose e que pode persistir, em menor intensidade, após o término do tratamento. Métodos de imagem constituem importantes recursos para o diagnóstico e acompanhamento da tuberculose pulmonar.
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Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest 2001; 120:1514-9. [PMID: 11713128 DOI: 10.1378/chest.120.5.1514] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To investigate the characteristics of tuberculosis infection in diabetic patients at Bellevue Hospital. DESIGN We conducted a case-control study retrospectively reviewing the records of patients at Bellevue Hospital Center from 1987 to 1997 with a discharge diagnosis of tuberculosis and diabetes mellitus. SETTING Bellevue Hospital Center is a 1,200-bed, inner-city municipal hospital located in the Lower East Side of New York City. PATIENTS Fifty-three identified patients had verified tuberculosis infection and diabetes; of these, 50 charts were available for review. One hundred five control cases were selected from nondiabetic patients with a discharge diagnosis of tuberculosis during the same time period. MEASUREMENTS AND RESULTS Thirty-six percent (18 cases) of the patients with diabetes and tuberculosis had multidrug-resistant tuberculosis (MDR-TB) compared to only 10% (10 cases) in the control group (p < 0.01) Controlling for homelessness, HIV status, and directly observed therapy, the relative risk of MDR-TB was calculated to be 8.6 (confidence interval, 3.1 to 23.6) in the diabetic group compared to the control group. CONCLUSIONS There was a significant association between diabetes and MDR-TB. Diabetes continues to be a risk factor for tuberculosis and was associated with MDR-TB in our patients.
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Affiliation(s)
- M Bashar
- Bellevue Chest Service, Division of Pulmonary and Critical Care Medicine, Department of Medicine and Environmental Medicine, New York University School of Medicine, New York 10016, USA
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Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH. Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am J Respir Crit Care Med 2000; 162:1738-40. [PMID: 11069805 DOI: 10.1164/ajrccm.162.5.2001040] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Atypical radiologic images of pulmonary tuberculosis are common in elderly and in diabetic patients. To investigate the relationship of chest radiographic findings of tuberculosis to age in diabetic and nondiabetic patients, we compared the chest radiographic findings of 192 inpatients with pulmonary tuberculosis and diabetes with those of 130 patients with pulmonary tuberculosis alone. The proportion of patients with lower lung field lesions progressively increased with age (r(S) = 0.89, p < 0.01), whereas the frequency of cavitation steadily decreased with age (r(S) = -0.79, p < 0.05). In diabetic patients, a high frequency of lower lung lesions and cavitation was observed in all age groups. We speculated that, in older patients and in diabetics, the increased alveolar oxygen pressure in the lower lobes favors development of lower lobe disease in these groups.
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Affiliation(s)
- C Perez-Guzman
- Instituto Nacional de Enfermedades Respiratorias, México DF, Mexico
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Wang CH, Yu CT, Lin HC, Liu CY, Kuo HP. Hypodense alveolar macrophages in patients with diabetes mellitus and active pulmonary tuberculosis. TUBERCLE AND LUNG DISEASE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE 2000; 79:235-42. [PMID: 10692992 DOI: 10.1054/tuld.1998.0167] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SETTING Alveolar macrophages (AM), a heterogeneous cell population, play a critical role in eliminating mycobacterial infections in collaboration with lymphocytes. Patients with diabetes mellitus (DM) show increased susceptibility to pulmonary tuberculosis (TB) infection. It is still uncertain whether there is a defect in T cell or AM activation in patients with DM against TB infection. OBJECTIVE To study the difference in activation status of AM and T cells between patients with TB + DM and TB alone. METHOD The heterogeneity of AM from 14 patients with TB + DM, 9 with TB alone, 10 normal subjects and 8 DM alone patients, was studied using Percoll density fractionation. The intracellular H2O2 production of AM before and after stimulation with phorbol myristate acetate (PMA) or F-Met-Leu-Phen (FMLP) was assayed by loading cells with 2',7'-dichlorofluorescin (DCFH) and analyzed by flow cytometry. Lymphocytes subsets (CD3, CD4, CD8) and their activation status (CD25) in bronchoalveolar lavage were also measured. RESULTS The proportion of the least dense AM (< 1,030 g/ml) and the magnitude of DCFH oxidation of AM was higher in TB patients than in normal subjects, regardless of DM. Patients with TB + DM had a significantly lower proportion of the least density AM fraction than TB alone patients, regardless of disease extent. Among TB patients, the proportion of the least dense AM was inversely correlated with the bacterial load on sputum and the disease extent on chest radiograph. Stimulation of AM with PMA or FMLP induced an increase in the hypodense AM subpopulations and enhanced intracellular H2O2 generation in patients with TB + DM and to a similar extent in normal subjects, but not in patients with TB alone. There was no significant difference in CD3 numbers, CD4/CD8 ratio, and CD25+ cells between patients with TB alone and TB + DM. The activation status of AM or T lymphocytes from DM alone patients was not significantly different from those from normal subjects. CONCLUSION Hypodense subpopulations of AM increase in active TB patients and are related to the disease severity as well as activation status of AM. AM in TB patients complicated with DM was less activated, and may be contributory to the susceptibility to mycobacterial infection.
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Affiliation(s)
- C H Wang
- Department of Thoracic Medicine II, Chang Gung Memorial Hospital, Taipei, Taiwan
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Affiliation(s)
- A N Leung
- Department of Radiology, Standard University Medical Center, CA 94305-5105, USA
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Umut S, Tosun GA, Yildirim N. Radiographic Location of Pulmonary Tuberculosis in Diabetic Patients. Chest 1994. [DOI: 10.1378/chest.106.1.326a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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