Clinical Spectrum and Medical Comorbidities in Tuberculosis: A Hospital-Based Study in Northeast India

Abstract

Background Tuberculosis (TB) is one of the most common infectious diseases and is commonly associated with comorbidities. However, data regarding TB and comorbidities are lacking from northeast India. The aim of the study is to see the clinical spectrum of TB and the frequency of comorbidities. Methods This was a prospective observational study of all hospitalized TB patients between January 2016 and June 2017 who were selected by consecutive sampling. Data were analyzed using SPSS v. 17.0 (IBM Corp., Armonk, NY), and a p-value of <0.05 was considered significant. Results Of the 173 patients selected, the mean age was 41.05±17.04 years with a male:female ratio of 4.27:1. Pulmonary TB (PTB) was found in 43.94%, extra-pulmonary TB (EPTB) in 52.02%, and disseminated TB in 4.04%. Fever (61.27%) was the most common presentation, followed by cough (54.33%) and breathlessness (32.94%). Of the 76 patients with PTB and seven with disseminated TB, making a total of 83 patients, 56 (67.4%) were sputum positive. Out of 90 patients suffering from EPTB, pleural effusion (53.33%) was the commonest type of EPTB, followed by central nervous system (CNS) tuberculosis (26.66%) and abdominal tuberculosis (8.88%). Comorbidities were present in 53.17% of the patients, of which diabetes mellitus (DM) (26.58%) and hypertension (17.34%) were the most common. Comorbid conditions were significantly higher in PTB than EPTB (51 of 83 vs. 41 of 90, p<0.05). Mean glycated hemoglobin (HbA1c) was significantly higher in PTB as compared to EPTB (8.74±2.04 vs. 7.58±0.29, p<0.05). Conclusion Comorbidities, particularly DM, were present in half of the patients, mostly in PTB than EPTB, with glycemic control being significantly poorer in PTB patients.

Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

“…A score of zero indicates no comorbidities. The higher the score, the more likely the predicted outcome will result in mortality or higher resource use ( 35 ). In the present study, the Charlson Comorbidity Index was associated with TB mortality.…”

“…On the other hand, comorbidities may restrict the use of some potent anti-TB drugs. Furthermore, TB itself can aggravate or impair the diagnosis and management of comorbidities ( 35 ).…”

Tuberculosis epidemic in India – a systematic review

“…Gender-specific data on TB-notified cases (India TB Annual Report 2019-2023) TB is the most lethal infectious disease in the world, and genital TB is a common complication in infertile people who receive inadequate clinical care. 30,57 When a pregnant TB patient cannot adequately protect, medications like isoniazid prophylaxis (3-6 months) or the Bacillus Calmette-Guerin (BCG) vaccine are administered to protect the neonates or newborns. 11,57,58 Factors mentioned in Fig.…”

“…20,28,66,75 It is a fact that diabetes is a well-known major risk factor for more than 25% of TB patients, which also plays a major role in altering the disease pattern from PTB to EPTB or DR-TB (rifampin resistance) due to the weak immune system. 3,20,23,30,32,71,75 Patients with PTB over 50, generally men with poor psychological status, who had a higher BMI, sedentary occupation, and positive family history of diabetes and were receiving Category II treatment were more likely to acquire diabetes and hypertension. 62,66 Diabetes has been strongly associated with an increased risk of early mortality in TB patients and has created an enormous challenge for TB treatments.…”

“…1,2,[16][17][18][19][20][21][22] Co-morbidities that weaken the immune system and increase the risks of TB infection in people over a short period of time include undernutrition, diabetes, HIV, tobacco use, smoking, and alcohol consumption. 2,[21][22][23][24][25][26][27][28][29][30][31][32] M. tuberculosis also has a diverse pattern of region-specific prevalence and susceptibility, genetic mutation over time, space, and environment. 23,33,34 Nearly one in every two TB patients' household contacts has latent TB, and the severity of the infection is related to the age of the household contacts.…”