Abstract
Background: Both smoking and diabetes are attributed to be strongly linked with pulmonary tuberculosis. The significance of the study lies in assessing severity of manifestations in pulmonary tuberculosis patients due to smoking and diabetes. Subjects and Methods:This is a cross sectional observational study among patients presenting to Department of Tuberculosis and Chest Diseases, Government Medical College, Patiala. 200 Patients were enrolled in this study who are sputum smear positive pulmonary kochs patients already on ATT and admitted in this department were evaluated by clinical history, blood and radiological investigations and the data was statistically analyzed.Results:Non smoker non diabetic group had maximum of females, n=28(56%), whereas purely diabetic study group has maximum of males, n=30(60%).The total number of patients whose sputum showed bacterial culture was 19 (9.5%). In the patients having both diabetes and smoking as risk factor there was maximum culture positivity, n=6 (31.5%)and most common organism isolated was klebsiella pneumonia, n=3 (50%), Klebsiella was also the most common organism isolated overall, n=10 (62.5%).Conclusion: The combination of smoking and diabetes can lead to serious disease, sputum positivity and complications.
Highlights
BackgroundBoth smoking and diabetes are attributed to be strongly linked with pulmonary tuberculosis
TB is one of the most important problems in India, with 1.98 million new cases per year, comprising over 20% of the global total for incident cases.[1]
This is a cross sectional and observational study where a total of 200 sputum smear positive pulmonary kochs patients already on ATT admitted in Department of chest and TB diseases, whose clinical history, sputum bacteriological investigation, smoking and diabetic status, blood investigations, radiological patterns analysed for the purpose of studying varying manifestations due to smoking and diabetes.50 diabetic patients, 50 smokers,50 patients who are both smoker and diabetics,50 patients who are neither smoker or diabetic are compared on basis of clinical symptoms, sputum AFB grading and radiological severity
Summary
Across the two groups who smoked it was found that there was a majority of ex-smokers, n=59(59%).Average smoking index of smoking non diabetic group was found to be 194.8 and average pack years was found to be 14.15.Average smoking index of smoker diabetic group was found to be 300 and average pack years found to be 20. In the smoker diabetic group of patients majority of the patients had a sputum AFB grading of 3+,n=27(54%) followed by 2+,n=13(26%) [Table 4]. In the patients having both diabetes and smoking as risk factor there was maximum culture positivity, n=6 (31.5%)and most common organism isolated was klebsiella pneumonia, n=3 (50%), Klebsiella was the most common organism isolated overall, n=10 (62.5%). Out of total 200 patients only 2 subjects were HIV positive both were from smoker diabetic population (1%) When data of radiological involvement was analysed it was found that more radiological involvement was found in groups having atleast one risk factor and maximum patients with far advanced radiological lesion was found to be from group having both smoking and diabetes, n=30 (60%) followed by diabetic group, n=27(54%) and smoker group, n=21(42%). The main strength of this study is the presence of a good control group
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