Drug Resistant Tuberculosis in Diabetes Mellitus: A Retrospective Study from South India

Abstract

This study was conducted in a tertiary care teaching hospital in south India to evaluate the association of drug resistant tuberculosis (TB) in diabetic subjects. There were: 361 subjects with positive mycobacterial culture and susceptibility tests results over a 3-year period; 267 (74%) acid-fast bacillus smear positive; and 94 (26%) smear negative cases. One hundred and seventy-seven (49%) had resistant isolates to any one first line antiTB drugs (resistant group) and 184 (51%) had isolates sensitive to all drugs (non-resistant group). In the resistant and non-resistant subjects the mean duration of TB symptoms was, respectively, 22 months and 4.5 months, past history of TB 126 (71%) and 48 (26%), past antiTB drug therapy 126 (71%) and 47 (25%), inadequate anti TB drug therapy 42 (24%) and 23 (13%), HIV positive six and 13 subjects. There were 72 diabetic subjects [35 and 37, respectively] with a duration of diabetes 5.8 +/- 7.5 years and 3.7 +/- 5.0 years in the resistant and non-resistant groups. Twenty-six per cent of the diabetic subjects (19/72) had multi-drug resistantTB. Drug resistance to first line anti-TB drugs was not found to be associated with diagnosis or duration of diabetes mellitus.

The Pattern of Presentation and Prevalence of Tuberculosis in HIV-Seropositive Patients Seen at Benin City, Nigeria

“…We found tuberculous adenitis as the most common type of extrapulmonary TB. However, other related studies have shown that tuberculosis of the spine (Potts disease) [5] and disseminated TB were the commonest [6]. The diagnosis of extrapulmonary TB is, however, usually difficult even in centres with sophisticated diagnostic facilities, as it usually requires biopsies and culture of various body fluids.…”

‘The tubercular diabetic': the impact of diabetes mellitus on tuberculosis and its threat to global tuberculosis control

“…16 Two studies have shown a significant association between diabetes and multidrug-resistant TB (MDR-TB), suggesting that diabetic patients may be more than five times as likely to have infection with MDR-TB. 5,17 However, contrasting results from other studies suggest that there is no association, 18,19 others even show a lower prevalence of drug resistance to antituberculous therapy compared to patients without DM. 14 Though existing evidence is inconclusive, the data does raise concern about the effect of DM on the clinical picture, disease severity and outcome of TB infection.…”

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…Although multiple studies have reported a positive association, with ORs ranging from 1·2 to 8·5, others have found no association. [33][34][35][36][37] Furthermore, many studies did not control for body-mass index, which is often high in people with type 2 diabetes, and can be associated with subtherapeutic serum drug concentrations that might lead to acquired resistance. In addition, the classification of patients simply as having type 2 diabetes without further stratification by glycaemic control, treatment modality, or renal function might result in the mixing of patients with substantially differing susceptibilities to drug resistance.…”