Pulmonary Tuberculosis in Patients with Diabetes mellitus

Abstract

Background: Diabetes mellitus has been reported to modify the presenting features of pulmonary tuberculosis, but there are varying data, particularly regarding the association with lower lung field involvement. Objectives: To determine whether diabetes mellitus alters the clinical and radiographic manifestations of tuberculosis in nonimmunocompromised hosts and to define the determinants of lower lung field involvement. Methods: A retrospective review of the records of all patients with tuberculosis and diabetes mellitus seen during a 14-year period and of an age- and sex-matched nondiabetic control group with tuberculosis was carried out. The duration of symptoms, tuberculin reaction, bacteriologic and radiographic findings of the two groups were compared. Results: The presence of diabetes mellitus was found not to have an effect on patients’ symptomatology, bacteriology results, tuberculin reaction and localization of pulmonary infiltrates. On the other hand, fewer diabetic patients were smear-positive and fewer had reticulonodular opacities compared with the control patients. A higher number of insulin-dependent diabetic patients presented with cavitary disease as compared with nondiabetic controls. Lower lung field tuberculosis was significantly associated with female gender and, in patients older than 40 years, was more frequently observed in diabetics. Conclusion: These data show that diabetes does not affect the presenting features of pulmonary tuberculosis to a large extent and is only associated with lower lung field disease in older patients.

Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific

“…19,20 The association between diabetes mellitus and TB has been well documented, and some studies report that smear-negative PTB is more common in people with diabetes, although this association may require rigorous studies to prove an association. [21][22][23] Information on diabetes mellitus was not collected during the study, and the association may warrant further research. In addition, knowledge, attitudes and behaviour of programmatic staff may infl uence the practice of diagnosing smear-negative PTB.…”

Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar

“…reported a mean ESR of 71.5 mm/h. (10) In a sample of 109 pulmonary tuberculosis patients, 38.5% of whom were co-infected with HIV, Dominguez-Castellano e al. reported a mean ESR of ≈65 mm/h.…”

“…(4,7,10,11) Although cavitation is the most widely reported chest X-ray finding in patients with PTB, the reported rates range from very low (in studies involving HIV-infected or otherwise immunocompromised patients, children, or the elderly) to very high (in patients with concomitant diabetes). (7,(9)(10)(11)23) Among patients with reactivation tuberculosis, cavitary lesions are reported to occur in 28-82%, the mean being 40-50%. (6,9,11,20,24) Kartaloglu e al.…”

“…(2)(3)(4)(5)(6)(7)(8) However, in patients with HIV infection, diabetes, silicosis or malignancy, especially in females and in the elderly, the lower lung fields can be involved. (2,4,7,(9)(10)(11)(12)(13) Although sputum smear and culture are the main tools for the diagnosis and follow-up of PTB, clinicians frequently use chest X-ray in the differential diagnosis and the assessment of treatment responses. The WHO Expert Committee on Tuberculosis Ninth Report, issued in 1974, (14) strongly discouraged the mass screening for tuberculosis through the use of chest X-rays.…”

An Observational Study to Determine the Impact of Glycaemic Control on Presentation of Drug Sensitive and Drug Resistant Pulmonary Tb in Type 2 Diabetes

“…19 A study done by Anand K Patel et al, which showed radiographic presentation of patients of pulmonary TB with DM showed higher involvement of lower lung field 84% when compared to upper lung field and cavitary lesions, more frequently confined to lower lung field. 22 A study done by Bokam et al showed that 59% had involvement of only lower lung fields, 29.5% upper lung fields and 11.3% had involvement of both upper and lower lung fields. 20 Another study done by Avuthu etal showed that patients with poor glycemic control are likely to have lower lung field involvement and cavitary disease on chest radiograph.…”