Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia

Koesoemadinata, Raspati C; McAllister, Susan; Soetedjo, Nanny Natalia Mulyani; Ratnaningsih, Dwi Febni; Ruslami, Rovina; Kerry, Sally; Verrall, Ayesha; Apriani, Lika; Crevel, Reinout van; Alisjahbana, Bachti; Hill, Philip C.

doi:10.1093/trstmh/trx015

Cited by 27 publications

(22 citation statements)

References 23 publications

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“…In India, a population-based study conducted in six large cities from different regions estimated an age-standardized prevalence of type 2 diabetes among TB patients to be 39.1%. [21], [22], [23] Similarly, cross-sectional studies from have estimated DM prevalence among TB patients to be 15.6%, 18.27% and 38.6%, respectively with a prevalence of 15.8% in rural areas of Puducherry [24], [25], [26], [27]. In the current study, the prevalence of DM in TB patients was found to be 37.2%.…”

Section: Discussionsupporting

confidence: 56%

Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

Mburu

Kingwara²,

Ester

et al. 2018

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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BackgroundThe double burden of diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the global health challenges. Studies done in different parts of the world indicate that 12%-44% of TB disease is associated with DM. In Kenya TB-DM co-morbidity data is scarce and is not readily available. In this study we set to determine the difference in treatment outcomes among TB and TB/DM comorbidity patients and their respective clinical and socio-demographic characteristics.ObjectiveTo determine prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya.MethodsWe carried out a prospective cohort study of non-pregnant patients aged 15 years and above that tested positive for TB in two peri‑urban counties in Kenya between February 2014 and August 2015. Clinical and socio demographic data were obtained from a questionnaire and medical records of the National TB program patient data base at two, three, five and six months. The data consisted of TB status, HIV status, TB lineage, County, (Glucose, %HbA1c, creatinine) weight, height, BMI, regimen, sex, level of education, employment status, distance from health facility, number of cigarettes smoked, home size, and diet. Univariate analysis was then used to compare each potential risk factor in the TB and TB/DM patients by the Pearson x2 test of proportions or fisher exact test, as appropriate.ResultsDM prevalence (HbA1c > 6%) among TB infected patients was 37.2%. Regimen, employment status, alcohol intake, smoking, age and household size were some of the factors associated with DM among TB patients at p-value < 0.05. The number of cigarettes smoked per day and the value of the BUN were significant risk factors of developing DM among TB patients (p values = 0.045). Mean time to conversion from positive to negative was slightly higher for the TB-DM patients compared to the TB patents, though not statistically significant (p = 0.365).ConclusionPatients regimen, employment status, alcohol intake, smoking, age and are associated with DM among TB patients.

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Section: Discussionsupporting

confidence: 56%

Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

Mburu

Kingwara²,

Ester

et al. 2018

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…M . tuberculosis pathogenesis and outcome of TB infection are impacted by several factors such as bacterial lineage [ 2 ], drug susceptibility of the strains [ 3 ], co-infection with HIV [ 4 ] or Cytomegalovirus (CMV) [ 5 ], comorbidities like diabetes [ 6 ], genetic predisposing factors (for instance IFN-γ/IL-12 deficiency [ 7 ]) and malnutrition [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Multicenter analysis of sputum microbiota in tuberculosis patients

et al. 2020

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The impact of tuberculosis and of anti-tuberculosis therapy on composition and modification of human lung microbiota has been the object of several investigations. However, no clear outcome has been presented so far and the relationship between M. tuberculosis pulmonary infection and the resident lung microbiota remains vague. In this work we describe the results obtained from a multicenter study of the microbiota of sputum samples from patients with tuberculosis or unrelated lung diseases and healthy donors recruited in Switzerland, Italy and Bangladesh, with the ultimate goal of discovering a microbiota-based biomarker associated with tuberculosis. Bacterial 16S rDNA amplification, high-throughput sequencing and extensive bioinformatic analyses revealed patient-specific flora and high variability in taxon abundance. No common signature could be identified among the individuals enrolled except for minor differences which were not consistent among the different geographical settings. Moreover, anti-tuberculosis therapy did not cause any important variation in microbiota diversity, thus precluding its exploitation as a biomarker for the follow up of tuberculosis patients undergoing treatment.

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“…Ample evidence supported an increased risk of developing TB disease for those with DM 5,8,10,42–50 . However, this evidence did not differentiate the precise biological mechanism of whether DM is associated with increased proportion of TB infections entering the LFI state, as opposed to the LSI state ( Effect 2-Fast progression) ; increased susceptibility to develop TB disease among those with LSI ( Effect 3-Reactivation ); and/or increased susceptibility to TB reinfection among those with LSI ( Effect 4-Primary reinfection ).…”

Section: Resultsmentioning

confidence: 99%

Analytical Exploration of Potential Pathways by which Diabetes Mellitus Impacts Tuberculosis Epidemiology

Awad

Dargham

Omori

et al. 2019

Sci Rep

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We aimed to develop a conceptual framework of diabetes mellitus (DM) effects on tuberculosis (TB) natural history and treatment outcomes, and to assess the impact of these effects on TB-transmission dynamics. The model was calibrated using TB data for India. A conceptual framework was developed based on a literature review, and then translated into a mathematical model to assess the impact of the DM-on-TB effects. The impact was analyzed using TB-disease incidence hazard ratio (HR) and population attributable fraction ( PAF ) measures. Evidence was identified for 10 plausible DM-on-TB effects. Assuming a flat change of 300% (meaning an effect size of 3.0) for each DM-on-TB effect, the HR ranged between 1.0 ( Effect 9-Recovery ) and 2.7 ( Effect 2-Fast progression ); most effects did not have an impact on the HR. Meanwhile, TB-disease incidence attributed directly and indirectly to each effect ranged between −4.6% ( Effect 7-TB mortality ) and 34.5% ( Effect 2-Fast progression ). The second largest impact was for Effect 6-Disease infectiousness at 29.9%. In conclusion, DM can affect TB-transmission dynamics in multiple ways, most of which are poorly characterized and difficult to assess in epidemiologic studies. The indirect (e.g. onward transmission) impacts of some DM-on-TB effects are comparable in scale to the direct impacts. While the impact of several effects on the HR was limited, the impact on the PAF was substantial suggesting that DM could be impacting TB epidemiology to a larger extent than previously thought.

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Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia

Abstract: LTBI prevalence in patients with DM was lower than in household contacts, but patients with DM were more likely to have TB disease. Further studies should explore possible benefits of LTBI screening and preventive therapy in patients with DM in TB-endemic settings.

Cited by 27 publications

References 23 publications

Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

Multicenter analysis of sputum microbiota in tuberculosis patients

Analytical Exploration of Potential Pathways by which Diabetes Mellitus Impacts Tuberculosis Epidemiology

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