Abstract
BackgroundDiabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response. Whether DM impacts radiological manifestations of pulmonary TB is still not clear. This study investigated the impact of glycemic status on radiological manifestations of pulmonary TB cases and its relationship with concentration of biochemical parameters in peripheral blood.MethodsA retrospective cross-sectional study used data from 132 microbiologically confirmed pulmonary TB patients from Lima, Peru, evaluated in a previous investigation performed between February and December 2017. Chest radiographs were analyzed by a radiologist and a pulmonologist. Radiographic lesions were identified as cavities, alveolar infiltrates and fibrous tracts. Hyperglycemia in TB patients was identified by use of fasting plasma glucose, HbA1c and oral glucose tolerance test. Clinical, biochemical and hematological parameters were also analyzed.ResultsTB patients with hyperglycemia presented more frequently with cavities, alveolar infiltrates and fibrous tracts than those with normoglycemia. Hierarchical clustering analysis indicated that patients with more diverse and higher number of lung lesions exhibited a distinct laboratorial profile characterized by heightened white blood cell counts and circulating levels of total cholesterol, triglycerides and transaminases and simultaneously low levels of albumin and hemoglobin. Multivariable regression analyses adjusted for age, sex, prior TB, hemoglobin levels and acid-fast bacilli ≥2+ in sputum smears, demonstrated that presence of prediabetes or diabetes in TB patients was associated with increased odds of having 3 pulmonary lesion types (p = 0.003 and p < 0.01 respectively) or ≥ 4 lesions (p = 0.001 and p = 0.01 respectively).ConclusionHyperglycemia (both DM and prediabetes) significantly affected the presentation of radiographic manifestations and the number of lesions in pulmonary TB patients as well as the biochemical profile in peripheral blood.
Highlights
Diabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response
In this study, from 349 microbiologically confirmed TB cases initially screened at the primary health care centers (Fig. 1), 206 individuals were excluded for a number of reasons listed in Fig. 1, and 143 patients with active TB were further examined
The diabetes mellitus (DM), PDM and normoglycemic groups were similar with regard to a number of other characteristics including sex, Bacillus Calmette–Guérin (BCG) vaccination, history of asthma and renal disease, as well as life-style habits such as use of alcohol, illicit drugs or smoking
Summary
Diabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response. This study investigated the impact of glycemic status on radiological manifestations of pulmonary TB cases and its relationship with concentration of biochemical parameters in peripheral blood. The association between diabetes mellitus (DM) and tuberculosis (TB) has been re-called to attention in the 1980s, when the global prevalence of DM in adults increased by 20% in less than 30 years [1]. In a recent study in Lima [8], we reported a much higher prevalence of DM (14%) and of PDM (31%) in TB patients. Both local and international agencies recommend both continuous screening for dysglycemia and tight glycemic control in people with active TB [9]. Several factors limit the ability of individuals to properly monitor glycemic status/control [10, 11]
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