Increased Incidence of Multidrug-Resistant Tuberculosis in Diabetic Patients on the Bellevue Chest Service, 1987 to 1997

Bashar, Mona; Alcabes, Phil; Rom, William N.; Condos, Rany

doi:10.1378/chest.120.5.1514

Cited by 136 publications

(113 citation statements)

References 8 publications

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“…There is strong evidence for this association, with studies examining the incidence of TB showing it to be two to five times higher in diabetic patients than in non-diabetic patients. [4][5][6] Calculations from an epidemiological model in India suggest that DM accounts for 14.8% of pulmonary TB and 20.2% of smear-positive TB. 7 It is estimated that an increased prevalence of DM in urban areas is associated with a 15.2% increased incidence of smear-positive pulmonary TB in urban, compared to rural, populations.…”

Section: Diabetes Increases the Incidence Of Tbmentioning

confidence: 99%

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

Bailey

Grant

2011

Clinical Medicine

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-The incidence and prevalence of diabetes mellitus (DM) is rapidly increasing across the globe. Tuberculosis (TB), meanwhile, remains a significant problem in low and middle income countries fuelled by high rates of HIV/AIDS. This article explores the long recognised but underappreciated connection between the two, revealing that DM makes a substantial contribution to the burden of incident TB around the world and may also worsen TB severity and treatment outcome. The dual management of the diseases may be challenging but must be addressed, both in low and high income settings, because the rising worldwide diabetes burden poses a threat to global TB control.

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Section: Diabetes Increases the Incidence Of Tbmentioning

confidence: 99%

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

Bailey

Grant

2011

Clinical Medicine

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“…27 Our study shows that weight gain is strongly associated with TB relapse, supporting the fi ndings of Khan et al 28 However, weight loss was also significantly associated with increased risk for relapse, corroborating the fi ndings of Benator et al 27 The positive association between diabetes and TB has been reported previously. 8,23,29 We confi rm that diabetes is an important factor for recurrent TB. However, the present fi ndings are inconsistent with those of a Brazilian study.…”

Section: Discussionmentioning

confidence: 51%

“…However, the present fi ndings are inconsistent with those of a Brazilian study. 30 The existence of a significant association between diabetes and relapse in our study may be due to malabsorption of anti-tuberculosis drugs among diabetic patients due to hyperglycaemia, 29 which may interfere with achieving adequate tissue levels of anti-tuberculosis drugs. The degree of hyperglycaemia has a distinct infl uence on the microbicidal function of macrophages and CD4 + cells.…”

Section: Discussionmentioning

confidence: 79%

A nested case-control study on relapse predictors among tuberculosis patients treated in Yemen's NTCP

Anaam

Ibrahim

Serouri

et al. 2012

public health action

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high relative relapse rate (RRR) of 6-11% between 1995 and 2009, exceeding the acceptable norm (<5%). [3][4][5] The present study was designed to measure the actual relapse rate and to identify associated risk factors. METHODS Study designA prospective nested case-control study was conducted to identify risk factors for relapse among TB patients. At the end of the follow-up period (28 February 2010), all those who relapsed within 12 months after completion of treatment were identifi ed from the tuberculosis registry. For each confi rmed relapse case, four control subjects were randomly selected from among patients who had successfully completed the initial phase of treatment and had not relapsed. Sampling was performed using the Statistical Package for the Social Sciences sampling procedure (Base 7.4 for Windows, SPSS Inc, Chicago, IL, USA). Study area and populationThe study was conducted at health centres with TB units throughout the 10 governorates of Yemen: Metropolitan, Amran, Aden, Taiz, Al-Hodeida, Hajjah, Ibb, Dhamar, Hadramout and Mareb. The study population was a cohort of smear-positive pulmonary TB (PTB) patients registered for DOTS-based treatment between July 2007 and June 2008. Patients who had completed treatment, were considered cured and were aged ⩾15 years were included as subjects, while all patients with smearnegative PTB and extra-pulmonary TB (EPTB), children aged <15 years and adult patients receiving other treatment regimens were excluded. SamplingThe calculation of the sample size for determining factors contributing to relapse was based on a balanced design for simple logistic regression with a binary covariate (X ). 6 In this method, the proportion (B) of the sample (X = 1) was assumed to be 0.5. The event rates P 1 and P 2 are 0.05 (X = 0) and 0.1 (X = 1), respectively. The power of the study was set at 80%, while the two-tailed type I error was assumed to be 5%. The sample size required to detect a change in probability (Y = 1) from a baseline value of 0.05 to 0.1 was 862 patients. Adjusting for the variance infl ation factor, a total sample size of 880 was needed for multiple logistic regression. Based on the required sample size and the number of patients available according to the previous years' statistics, it was decided that recruitment of all patients within the timeframe July 2007 to June 2008 would provide an adequate sample size. Results: A relapse rate of 5.7% was found. Multivariate logistic regression analysis showed that unemployment, smoking, presence of cavitations, weight gain, weight loss, non-adherence during the continuation phase and diabetes were significantly associated with relapse (P < 0.05). Interna onal Union Against Tuberculosis and Lung Disease Conclusion:Relapse rates can be reduced by ensuring that patients take their treatment regularly and are counselled effectively to stop smoking. Reinforcing the implementation of the DOTS strategy and strengthening the anti-smoking campaigns are important actions. Action to help unemployed patients, including free...

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“…Al analizar este grupo de 6 pacientes, se puede resaltar que 3 de ellos eran diabéticos, posiblemente presentaron recaída por pobre TOBÓN A., PANIAGUA L., HENAO M., ARCILA V., MAYA J., et al respuesta al tratamiento antituberculoso al tener alteraciones de tipo inmune y mayor riesgo para multirresistencia (28)(29)(30). Dos pacientes presentaban lesiones fibrocavitarias bilaterales y uno abandonó el tratamiento luego de la cirugía.…”

Section: Discussionunclassified

Cirugía en tuberculosis pulmonar multirresistente.

Tobón¹,

Paniagua²,

Henao³

et al. 2004

biomedica

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La aparición de Mycobacterium tuberculosis multirresistente constituye un serio problema para el control de la tuberculosis, por lo que se ha considerado que la resección quirúrgica del tejido pulmonar afectado, junto con el tratamiento médico adecuado, podría proporcionar la curación en algunos pacientes con tuberculosis pulmonar multiresistente. En este estudio de tipo descriptivo, retrospectivo, se evaluaron los resultados clínicos y bacteriológicos de la resección quirúrgica en un grupo seleccionado de pacientes con tuberculosis pulmonar multirresistente. Se revisaron las historias clínicas del Hospital La María de Medellín de 1990 a 2000, y se encontró que se habían sometido a cirugía 73 pacientes con diagnóstico de tuberculosis durante este periodo, 28 de los cuales tenían como indicación quirúrgica tuberculosis multirresistente (resistencia a isoniacida y rifampicina), 21 de los cuales habían recibido tratamiento prequirúrgico. En 14 (50%) se había practicado lobectomía superior y en 10 (36,7%), neumonectomía. Todos recibieron tratamiento posquirúrgico por un periodo promedio de 12,5 meses. En 88,9% (25/27) de los casos, la baciloscopia fue negativa después de 6 semanas de la cirugía y hasta finalizar el tratamiento antituberculoso; 6 pacientes presentaron nuevamente baciloscopia positiva, aunque 4 tuvieron baciloscopia negativa después de un nuevo esquema de tratamiento. Los pacientes, de acuerdo con las normas del ministerio, fueron seguidos con baciloscopia mensual y no con cultivo como es lo indicado en los casos de multirresistencia. La cirugía junto con el tratamiento médico adecuado constituye una buena alternativa de curación para algunos pacientes con tuberculosis pulmonar multirresistente.

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Increased Incidence of Multidrug-Resistant Tuberculosis in Diabetic Patients on the Bellevue Chest Service, 1987 to 1997

Cited by 136 publications

References 8 publications

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

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

A nested case-control study on relapse predictors among tuberculosis patients treated in Yemen's NTCP

Cirugía en tuberculosis pulmonar multirresistente.

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