Diabetes mellitus and tuberculosis

Diabetes mellitus: an important risk factor for reactivation of tuberculosis

Diabetes mellitus was identified as a risk factor for developing tuberculosis (TB) infection, and relapse after therapy. The risk of acquiring TB is described as comparable to that of HIV population. The fact that diabetics are 3× times more prone to develop pulmonary TB than nondiabetics cannot be overlooked. With DM recognized as global epidemic, and TB affecting one-third of the world population, physicians must remain vigilant. We present a 45-year-old woman born in Dominican Republic (DR), with 10-year history of T2DM treated with metformin, arrived to our Urgency Room complaining of dry cough for the past 3months. Interview unveiled unintentional 15lbs weight loss, night sweats, occasional unquantified fever, and general malaise but denied bloody sputum. She traveled to DR 2years before, with no known ill exposure. Physical examination showed a thin body habitus, otherwise well appearing woman with stable vital signs, presenting solely right middle lung field ronchi. LDH, ESR, hsCRP and Hg A1C were elevated. Imaging revealed a right middle lobe cavitation. Sputum for AFB disclosed active pulmonary TB. Our case portrays that the consideration of TB as differential diagnosis in diabetics should be exercised with the same strength, as it is undertaken during the evaluation of HIV patients with lung cavitation. Inability to recognize TB will endanger the patient, hospital dwellers and staff, and perpetuate this global public health menace.

Achievements in and Challenges of Tuberculosis Control in South Korea

Despite astounding economic growth and TB control efforts, incidence remains the highest among high-income countries.

After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world.

A spatial, social and environmental study of tuberculosis in China using statistical and GIS technology

Tuberculosis (TB) remains a major public health problem in China, and its incidence shows certain regional disparities. Systematic investigations of the social and environmental factors influencing TB are necessary for the prevention and control of the disease. Data on cases were obtained from the Chinese Center for Disease and Prevention. Social and environmental variables were tabulated to investigate the latent factor structure of the data using exploratory factor analysis (EFA). Partial least square path modeling (PLS-PM) was used to analyze the complex causal relationship and hysteresis effects between the factors and TB prevalence. A geographically weighted regression (GWR) model was used to explore the local association between factors and TB prevalence. EFA and PLS-PM indicated significant associations between TB prevalence and its latent factors. Altitude, longitude, climate, and education burden played an important role; primary industry employment, population density, air quality, and economic level had hysteresis with different lag time; health service and unemployment played a limited role but had limited hysteresis. Additionally, the GWR model showed that each latent factor had different effects on TB prevalence in different areas. It is necessary to formulate regional measures and strategies for TB control and prevention in China according to the local regional effects of specific factors.

Exploration of ecological factors related to the spatial heterogeneity of tuberculosis prevalence in P. R. China

Background

The current prevalence of tuberculosis (TB) in the People's Republic of China (P. R. China) demonstrates geographical heterogeneities, which show that the TB prevalence in the remote areas of Western China is more serious than that in the coastal plain of Eastern China. Although a lot of ecological studies have been applied in the exploration on the regional difference of disease risks, there is still a paucity of ecological studies on TB prevalence in P. R. China.

Objective

To understand the underlying factors contributing to the regional inequity of TB burden in P. R. China by using an ecological approach and, thus, aiming to provide a basis to eliminate the TB spatial heterogeneity in the near future.

Design

Latent ecological variables were identified by using exploratory factor analysis from data obtained from four sources, i.e. the databases of the National TB Control Programme (2001–2010) in P. R. China, the China Health Statistical Yearbook during 2002–2011, the China Statistical Yearbook during 2002–2011, and the provincial government websites in 2013. Partial least squares path modelling was chosen to construct the structural equation model to evaluate the relationship between TB prevalence and ecological variables. Furthermore, a geographically weighted regression model was used to explore the local spatial heterogeneity in the relationships.

Results

The latent ecological variables in terms of ‘TB prevalence’, ‘TB investment’, ‘TB service’, ‘health investment’, ‘health level’, ‘economic level’, ‘air quality’, ‘climatic factor’ and ‘geographic factor’ were identified. With the exception of TB service and health levels, other ecological factors had explicit and significant impacts on TB prevalence to varying degrees. Additionally, each ecological factor had different impacts on TB prevalence in different regions significantly.

Conclusion

Ecological factors that were found predictive of TB prevalence in P. R. China are essential to take into account in the formulation of locally comprehensive strategies and interventions aiming to tailor the TB control and prevention programme into local settings in each ecozone.