Tuberculosis and diabetes mellitus: convergence of two epidemics

Dooley, Kelly E.; Chaisson, Richard E.

doi:10.1016/s1473-3099(09)70282-8

Cited by 753 publications

(773 citation statements)

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“…In agreement with our findings, previous studies have reported high mortality rates in non-HIVinfected immunocompromised patients. (5)(6)(7)(8)(9)(10) and 5 days (IQR: 2-11 days) in the other patients (p = 0.021). The initiation of treatment was also delayed in patients with diabetes and in those with chronic renal failure-10 days (IQR: 7-17 days) vs. 5 days (IQR: 2-11 days; p = 0.005) and 12 days (IQR: 8.0-15.5 days) vs. 5 days (IQR: 2-11 days; p = 0.018), respectively.…”

Section: Discussionmentioning

confidence: 91%

“…In non-HIV-infected immunocompromised patients, TB can be as severe as it is in HIV-infected patients and is associated with high mortality. (5)(6)(7)(8)(9)(10) The objective of this study was to investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

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Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients. Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host. ResumoObjetivo: Investigar as características de pacientes imunocomprometidos não HIV com diagnóstico intrahospitalar de tuberculose e determinar os fatores de risco para mortalidade. Métodos: Durante um período de dois anos, foi realizado um estudo de coorte retrospectivo que incluiu os pacientes com diagnóstico de tuberculose após a internação. Os fatores preditores de mortalidade foram coletados. Resultados: Durante o período do estudo, 337 pacientes foram internados e diagnosticados com TB, e desses, 61 apresentavam imunossupressão não decorrente da infecção pelo HIV. A tuberculose extrapulmonar estava presente em 47,5% dos casos. Nesse grupo, a taxa de mortalidade intra-hospitalar foi de 21,3%, e a mortalidade após a alta foi de 18,8%. Os pacientes imunocompetentes tiveram sobrevida em um ano maior que os pacientes com HIV (p = 0,008) e que os imunocomprometidos não HIV (p = 0,015), mas não houve diferença na sobrevida entre esses dois últimos grupos (p = 0,848). Entre os pacientes imunocomprometidos não HIV, o único fator estatis...

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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“…Among the many risk factors for the development of tuberculosis, type 2 diabetes mellitus is one that has long been recognized through clinical and epidemiological studies (1). There is growing evidence that type 2 diabetes mellitus is an important risk factor for developing active pulmonary tuberculosis (2).…”

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confidence: 99%

“…Enhanced susceptibility to tuberculosis in patients with diabetes mellitus has been ascribed to several factors including those related directly to hyperglycemia and insulin resistance as well as to indirect effects on macrophage and lymphocyte function (1). Several early studies reported reduced proinflammatory cytokines in patients with diabetes after infection with Mycobacterium tuberculosis (3,4).…”

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confidence: 99%

Type 2 Diabetes Mellitus Coincident with Pulmonary Tuberculosis Is Associated with Heightened Systemic Type 1, Type 17, and Other Proinflammatory Cytokines

et al. 2013

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Rationale: Type 2 diabetes mellitus is a major risk factor for the development of active tuberculosis, although the biological basis underlying this susceptibility remains poorly characterized. Objectives and Methods:To identify the influence of coincident diabetes mellitus on cytokine levels in pulmonary tuberculosis, we examined circulating levels of a panel of cytokines and chemokines in the plasma of individuals with tuberculosis with diabetes and compared them with those of individuals without diabetes. Measurements and Main Results:Tuberculosis with diabetes is characterized by elevated circulating levels of type 1 (IFN-g, tumor necrosis factor-a, and IL-2), type 2 (IL-5), and type 17 (IL-17A) cytokines but decreased circulating levels of IL-22. This was associated with increased systemic levels of other proinflammatory cytokines (IL-1b, IL-6, and IL-18) and an antiinflammatory cytokine (IL-10) but not type 1 IFNs. Moreover, tuberculosis antigenstimulated whole blood also showed increased levels of proinflammatory cytokines. Finally, type 1 and type 17 cytokines in plasma exhibit a significant positive correlation with hemoglobin A1C levels, indicating that impaired control of diabetes is associated with this proinflammatory milieu. Multivariate analysis revealed that the association of proinflammatory cytokines with diabetes mellitus was not influenced by age, sex, or other metabolic parameters.Conclusions: Our data reveal that tuberculosis with diabetes is characterized by heightened cytokine responsiveness, indicating that chronic inflammation underlying type 2 diabetes potentially contributes to increased immune pathology and poor control in tuberculosis infection.

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“…12,13 On the other hand, TB may induce glucose intolerance and aggravate glycemic control in patients with DM. 14,15 The higher susceptibility of TB in diabetics may be related to a longer duration of disease or due to poor control of glycemic status. 16 Poor glycemic control has been significantly associated with the occurrence of TB.…”

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confidence: 99%

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

Mahmood¹,

Verma²,

Ahmad³

et al. 2018

jemds

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BACKGROUND There is a strong correlation between the two diseases, diabetes and tuberculosis, with impact of one on the other. Poor glycaemic control causes poor outcome of tuberculosis treatment and that can be observed radiologically and microbiologically beside clinical observation.The aim of the study is to study the impact of glycemic control on presentation (clinical, radiological and microbiological) of drug sensitive and drug resistant pulmonary TB in type 2 diabetes. MATERIALS AND METHODSThis is an observational cross-sectional study. Patients above 18 years, having PTB with DM over one year were included. PTB with other conditions like HIV, Pregnancy, Connective tissue disorders, Chronic renal failure, Chronic liver disease, Malignancy, on longterm steroid use or cytotoxic drug therapy or on immunosuppressive drugs were not included in this study. Glycemic control was assessed by A1c < 7 as controlled and > 7 as uncontrolled. Clinical, Microbiological and Radiographic parameters of the patients were studied in respect to their glycemic control. RESULTS263 PTB patients who were screened for the study, out of which 94 were diabetic. The prevalence of D Min PTB patients was found to be 35.7% (out of 180 drug-sensitive PTB patients 68 were diabetic and out of 83 drug resistant PTB patients 26 were diabetic). The overall mean age was (50 ± 9) years, maximum no. of patients (60%) were in 40 -60 years' age group, 70% males with mean A1c (8.54 ± 0.03), 81% had uncontrolled glycemic status and 100% had cough with mean A1c (8.47 ± 0.03). 81% were sputum AFB positive with mean A1c (8.64 ± 0.014), 75.5% had lower lung field abnormalities with mean A1c (8.61 ± 0.094), 12.57% upper lung field with mean A1c (7.53 ± 0.012), 9.5% both lung fields with mean A1c (9.19 ± 0.082), 84% had infiltrative lesions with mean A1c (8.45 ± 0.017) and 25.5% had cavities with high mean A1c (10.04 ± 0.029). CONCLUSIONThe association between DM and TB is the most emerging challenge for global TB control. Poor glycemic control has significant effect on sputum smear positivity, more cavity formation and lower lung field involvement with no effect on clinical symptom. Hence, with the help of this study, it can be concluded that screening for DM should be performed routinely in patients with TB that may improve treatment outcomes. Submission 30-12-2017, Peer Review 27-01-2018, Acceptance 01-02-2018, Published 12-02-2018. Corresponding Author: Dr. Tariq Mahmood, Professor and HOD, Department of Pulmonary Medicine, MLN Medical College, Allahabad-211001, Uttar Pradesh, India. E-mail: mlnmctariqmahmood@gmail.com DOI: 10.14260/jemds/2018 An estimated 10.4 million people fell ill with TB in 2016: 90% were adults, 65% were male, 10% were people living with HIV (74% in Africa) and 56% were in five countries: India, Indonesia, China, the Philippines and Pakistan. Drugresistant TB is a continuing threat to world community. In 2016, there were 6 lakh new cases with resistance to rifampicin, the most effective first-line drug, of whi...

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Tuberculosis and diabetes mellitus: convergence of two epidemics

Cited by 753 publications

References 77 publications

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Type 2 Diabetes Mellitus Coincident with Pulmonary Tuberculosis Is Associated with Heightened Systemic Type 1, Type 17, and Other Proinflammatory Cytokines

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

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