Diabetes mellitus and extrapulmonary tuberculosis: site distribution and risk of mortality

Abstract

Summary Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ≥16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27.8%) had any EPTB including 258 (19.5%) with only EPTB and 111 (8.4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11.9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1.04, 95% confidence interval (CI) 0.70–1.56]. The risk of death was 23.8% in patients with EPTB and diabetes vs. 9.8% in those with no diabetes (P < 0.01); after adjusting for covariates the difference was not significant (aRR 1.19, 95% CI 0.54–2.63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.

Risk factors for extrapulmonary dissemination of tuberculosis and associated mortality during treatment for extrapulmonary tuberculosis

“…According to a 2016 CDC report, high rates of TB cases overall and TB cases attributable to extensive recent transmission were identified frequently among people experiencing homelessness within the past year and residents of a correctional facility at the time of diagnosis 28 . However, EPTB was more common in non-homeless patients than in the homeless, as previously reported 5 , 17 . The number of homeless cases was significantly higher in PTB (5.8%) than in exclusively EPTB (2.4%) in our population.…”

“…The observed demographics of female gender and foreign-born origin in the USA have been previously reported as risk factors for EPTB 5 , 12 , 17 , 19 , 20 . Similarly, we found that female gender and Hispanic ethnicity were associated with patients who presented with exclusively EPTB after adjusting for other confounding factors.…”

“…Drug users and the elderly remain the groups at high risk of developing LTBI and TB disease 19 . The prevalence of illicit drug use has been previously shown to be higher in patients with PTB than in patients with EPTB 15 , 17 . Similarly, the prevalence of injecting drug use and non-injecting drug use was also higher in patients with PTB than patients with exclusively EPTB in our study.…”

“…Although risk factors for the development of exclusively EPTB compared to PTB have been described in several studies 5 , 12 , 16 , 17 , there are still inconsistent findings among studies from different regions, including substantial state-level heterogeneity in the reported epidemiological data 18 . We performed an analysis of EPTB patients in the state of Texas.…”

Primary Adenocarcinoma of the Endometrium Coincide with Tuberculous Lymphadenitis

“…This is attributed to the weak immunity of this group of patients. According to a study published recently, diabetes was common in patients with EPTB 10 .…”