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DIABETES IS ASSOCIATED WITH WORSE CLINICAL PRESENTATION IN TUBERCULOSIS PATIENTS FROM BRAZIL: A RETROSPECTIVE COHORT STUDY
Complicações do Diabetes
Humanos
Adultos
Prevalência
Feminino
Fatores de Risco
Tuberculose Pulmonar
Diabetes Complications
Adult
Humans
Female
Prevalence
Risk Factors
Tuberculosis, Pulmonary
Author
Affilliation
Abstract
The rising prevalence of diabetes mellitus (DM) worldwide, especially in developing countries, and the persistence of tuberculosis (TB) as a major public health issue in these same regions, emphasize the importance of investigating this association. Here, we compared the clinical profile and disease outcomes of TB patients with or without coincident DM in a TB reference center in Brazil. Methods
We performed a retrospective analysis of a TB patient cohort (treatment naïve) of 408 individuals
recruited at a TB primary care center in Brazil between 2004 and 2010. Data on
diagnosis of TB and DM were used to define the groups. The study groups were compared
with regard to TB disease presentation at diagnosis as well as to clinical outcomes such as
cure and mortality rates upon anti-tuberculosis therapy (ATT) initiation. A composite score
utilizing clinical, radiological and microbiological parameters was used to compare TB
severity between the groups.
Results
DM patients were older than non-diabetic TB patients. In addition, diabetic individuals more
frequently presented with cough, night sweats, hemoptysis and malaise than those without
DM. The overall pattern of lung lesions assessed by chest radiographic examination was
PLOS similar between the groups. Compared to non-diabetic patients, those with TB-diabetes
exhibited positive acid-fast bacilli in sputum samples more frequently at diagnosis and at 30
days after ATT initiation. Notably, higher values of the TB severity score were significantly
associated with TB-diabetes comorbidity after adjustment for confounding factors. Moreover,
during ATT, diabetic patients required more frequent transfers to TB reference hospitals
for complex clinical management. Nevertheless, overall mortality and cure rates were
indistinguishable between the study groups.
Conclusions These findings reinforce the idea that diabetes negatively impacts pulmonary TB severity.
Our study argues for the systematic screening for DM in TB reference centers in endemic
areas.
Keywords in Portuguese
Diabetes MellitusComplicações do Diabetes
Humanos
Adultos
Prevalência
Feminino
Fatores de Risco
Tuberculose Pulmonar
Keywords
Diabetes MellitusDiabetes Complications
Adult
Humans
Female
Prevalence
Risk Factors
Tuberculosis, Pulmonary
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