Lower Lung Field Involvement Research Articles

Effects of Hyperglycemia on Presentations of Pulmonary Tuberculosis in Diabetic Patients

Background: Diabetes Mellitus (DM) is a clinical syndrome characterized by chronic hyperglycemia and have multifactorial effects on immunity which increase the liability for infections with higher risk of lower respiratory tract infections including pulmonary tuberculosis (PTB).Objective: To assess the effects of hyperglycemia in DM on the clinical, bacteriological and radiological presentations of pulmonary tuberculosis.Methods: This study enrolled 25 tuberculous patients out of 310 diabetic patients who attend to the out-patient clinic of DM at Al- Diwaniya Teaching Hospital, they were studied during the period from 1st of October 2009 to 31st of March 2010.
 Results: This study revealed that male to female ratio was 4:1. 16% of the patients were type 1 DM, 56% were diabetic ≤10 years, 12% had fasting blood sugar (FBS) ≤6.9 mmol/l, 84% had HbA1c level ≥7.0%, 24% had positive history of pulmonary tuberculosis and 76% had positive sputum smear for acid fast bacilli (AFB). Multiple lobe involvement, cavitary lesions, lower lung field involvement and pleural effusion had been diagnosed in 64%, 60%, 32% and 16% of the sample respectively.Conclusions: This study revealed that DM affects the clinical, bacteriological and radiological picture of PTB. Diabetic patients have a higher risk for recurrence of PTB.

Pulmonary tuberculosis among hospitalized patients in Brazzaville: impact of late diagnosis of HIV infection on radiographic abnormalities

L’objectif de notre étude était de décrire les différents aspects radiographiques de la tuberculose pulmonaire selon le degré de l’immunodépression chez les patients VIH. Nous rapportons une étude rétrospective de 80 patients VIH positif non traités présentant une tuberculose pulmonaire, hospitalisés dans le service de Pneumo-phtisiologie de Brazzaville de Janvier 2013 à Janvier 2014. Notre échantillon était composé de 44 femmes (55%) et 36 hommes (45%) soit un sex ratio de 0,81. La moyenne d’âge était de 37,5±9,17ans, la moyenne du Taux de CD4 était de 153,13±86,6cell/mm3. La microscopie des expectorations à la recherche des bacilles acido-alcoolo-résistants était positive dans 75% des cas chez les patients ayant un taux de lymphocytes T CD4>200cell/ mm3. Les adénopathies médiastinales, les atteintes moyennes, inferieures du champ pulmonaire et la miliaire étaient plus fréquentes chez les patients ayant un taux de lymphocytes T CD4< 200cell/ mm3. L’immunodépression sévère est significativement associée à la présentation radiographique atypique de la tuberculose.

Association of type ii diabetes mellitus with pulmonary tuberculosis: a clinical and radiological study

Background: The link between diabetes mellitus and tuberculosis has been recognized for centuries. It is only in the later years that the association has been identified. 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. Methods: 229 pulmonary/pleural fluid TB positive patients were tested for presence of type II diabetes. Clinical and radiological tests were done and analyzed for all patients. Results: 109 of 229 patients were diabetic and more than 50% of them were males. The most common symptoms were loss of appetite and weight, followed by cough and fever. Mixed zone involvement of the lung was a more common presentation than upper or lower zone. Conclusions: We have tried to highlight the importance of Diabetes mellitus as a potential risk factor for Pulmonary tuberculosis patients, especially in the geographical regions were the two diseases are highly prevalent. More studies need to be performed in a region to establish the association between the two.

Tuberculosis and diabetes: the deadly duo

Background: With diabetes on the rise globally and with enormous pools of latent TB infection and high burdens of active disease in many countries, tuberculosis-diabetes is a looming co-epidemic. Furthermore, in countries where diabetes is escalating and tuberculosis rates are already high, diabetes will increasingly impede efforts to control tuberculosis. Methods: A prospective study including fifty diabetic and fifty non diabetic sputum positive pulmonary tuberculosis patients was conducted for a period of one year. Thorough clinical examination, relevant investigations like blood sugars, chest X-ray, and smear for acid fast bacilli were done and results analyzed statistically. Results: Though there is no significant difference in the clinical symptoms in both the groups, diabetic tuberculosis patients have prominent clinical severity at the onset, a greater degree of lung involvement and residual changes. There is predominance of lower zone involvement (56%) in diabetic patients and upper and mid zone involvement in non-diabetics. Extensive bilateral lesions and cavitations were more in diabetic patients. Sputum negativity after completion of intensive phase treatment was lower in diabetic patients compared to non-diabetics. Patients on insulin have better sputum conversion (94%) in comparison with oral hypoglycemic agents (76%). Relapse rate was high in diabetics (23.3%) compared to non-diabetics (8%). Conclusions: Diabetes mellitus is growing rapidly worldwide and is increasingly fueling the spread of tuberculosis. Atypical presentations like lower lung field involvement and cavitations were common. Strict glycaemic control enhances the sputum clearance and results in better patient outcome.

Impact of diabetes on the presenting features of tuberculosis in hospitalized patients

IntroductionDiabetes mellitus (DM) is a risk factor for tuberculosis (TB) and may modify its presenting features.The aim of this study was to find out the influence of DM on clinical, radiological and treatment features of TB in hospitalized patients. Material and methodsIn a retrospective study we reviewed the records of 123 patients with TB and DM admitted from 2000 to 2008 and compared this group with another one of 123 patients with TB without DM. ResultsAlthough in both groups multilobar lung lesions predominated, there were more cases of isolated lower lung field (LLF) involvement in diabetics than in nondiabetics (10.6% vs 3.3%, p=0.03). Cavitary lesions were less frequent (63.4% vs 82.1%, p=0.01) and extra-pulmonary TB manifestations were more frequent (28.5% vs 16.3%, p=0.02) in diabetics than in nondiabetics. There were no significant differences between groups regarding multidrug resistant – TB (MDR-TB) and adverse effects of anti-tuberculosis drugs. The in-hospital mortality was higher in diabetics (8.1% vs 0.8%, p=0.01), but using a binary logistic regression there was significant difference in mortality only in respect to the variable MDR-TB. ConclusionsThis study showed that DM affected some clinical and radiological presenting features in hospitalized TB patients. LLF involvement and extra-pulmonary TB manifestations were more frequent in diabetic patients than in nondiabetic ones.

Impacto da diabetes na forma de apresentação da tuberculose em doentes hospitalizados

IntroductionDiabetes mellitus (DM) is a risk factor for tuberculosis (TB) and may modify its presenting features. The aim of this study was to find out the influence of DM on clinical, radiological and treatment features of TB in hospitalized patients. Material and methodsIn a retrospective study we reviewed the records of 123 patients with TB and DM admitted from 2000 to 2008 and compared this group with another one of 123 patients with TB without DM. ResultsAlthough in both groups multilobar lung lesions predominated, there were more cases of isolated lower lung field (LLF) involvement in diabetics than in nondiabetics (10.6% vs 3.3% p=0.03). Cavitary lesions were less frequent (63.4% vs 82.1% p=0.01) and extra-pulmonary TB manifestations were more frequent (28.5% vs 16.3% p=0.02) in diabetics than in nondiabetics. There were no significant differences between groups regarding multidrug resistant - TB (MDR-TB) and adverse effects of anti-tuberculosis drugs. The in-hospital mortality was higher in diabetics (8.1% vs 0.8% p=0.01), but using a binary logistic regression there was significant difference in mortality only in respect to the variable MDR-TB. ConclusionsThis study showed that DM affected some clinical and radiological presenting features in hospitalized TB patients. LLF involvement and extra-pulmonary TB manifestations were more frequent in diabetic patients than in nondiabetic ones.

Mycobacterial Infections in the Elderly

In 2008, elderly subjects accounted for more than 262,000 cases of smear-positive tuberculosis worldwide, reaching the highest age-adjusted rates in some regions. Elders are at a greater risk for reactivation of latent tuberculosis or acquisition of new infection, especially if they live in long-term care facilities or are smokers. Once overt clinical tuberculosis appears, they are at increased risk of hospitalization and death. Pulmonary tuberculosis presentation may be atypical in elderly people, as they tend to have lower prevalence of fever, sweating, or hemoptysis, and their chest x-rays show less cavities and more lower lung field involvement. Compared with younger patients, tuberculous elders seem to have lower frequency of positive PPD, but differences in sputum smear positivity are not clear. Regimen recommended for treating new cases of pulmonary tuberculosis is not different from other age groups: a two-month bactericidal phase with daily oral administration of isoniazid, rifampin, pyrazinamide, and ethambutol, and a continuation phase with isoniazid and rifampin daily during four months, though some variations are allowed. Directly observed strategy is highly recommended in the initial phase. Elders with pulmonary tuberculosis may require longer time to become smear negative and seem to have worse outcomes than younger patients.

Radiological Pattern of Pulmonary Tuberculosis in Diabetes Mellitus

th in world ranking of diabetes mellitus prevalence. When two diseases are common, these can effect each other in terms of clinical presentation and course of the disease. In pulmonary tuberculosis with diabetes mellitus radiological pattern of may be different from patients without diabetes mellitus. Objective: To determine the radiological pattern of pulmonary tuberculosis in diabetes mellitus. Study Design: A prospective-observational study. Place of Study: The study was conducted in B.V. Hospital, Bahawalpur. Duration of Study: The study was conducted from January 2004 to December 2006. Material and Methods: One hundred and fifty patients with diabetes mellitus (both type 1 and type 2) and pulmonary tuberculosis were included in the study. Pulmonary tuberculosis was diagnosed on the basis of AFB positive sputum, history and radiological findings suggestive of pulmonary tuberculosis. Two physicians (including one chest physician) and a radiologist reviewed the chest radiographs. Those x-rays were selected in which there was no difference of opinion. Diabetic patients were either known diabetics or they were newly diagnosed based on WHO criteria. Results: A total of 150 patients were analyzed in which there was 105 were male and 45 females. The age range was 18 years to 75 years. The mean age was 49.81 and standard deviation was +12.28. Out of 150 films 69 (46%) showed the typical pattern (patchy infiltration / nodular pattern with or without cavitation) involving upper zone. While 81 (54%) pts showed the atypical pattern with lower lung field involvement. Out of 150 films, in 84 right lung was involved, in left lung about 39 and bilateral lesion found in 27 films. In 75 films x-rays showed non homogeneous opacity, cavity in 31 and homogeneous shadows in 22 and multiple shadows in 22 films. Among lower lung field involvement with pulmonary tuberculosis 50.6% were above the age of 50 years.

The Impact of Age on the Demographic, Clinical, Radiographic Characteristics and Treatment Outcomes of Pulmonary Tuberculosis Patients in Taiwan

The characteristics of pulmonary tuberculosis (TB) in the elderly are different from young patients. This leads to delay in diagnosis and higher mortality from TB in the aged population. The aim of this study was to investigate the impact of age on the demographic, clinical, radiographic characteristics, and treatment outcomes of pulmonary TB patients in Taiwan. We performed a retrospective analysis of the medical charts and chest radiographs of 83 elderly (> or =60 years old) and 74 young (< 60 years old) culture-proven pulmonary TB patients from 1 August 2003 to 31 July 2006. Elderly patients showed lower frequencies of infectious TB contact history, alcoholism, cavity, and positive acid-fast bacilli sputum smears. In contrast, the elderly population had higher frequencies of chronic obstructive lung disease, heart failure, stroke, dyspnea, lower lung field involvement, pleural effusion and mortality. There were no differences between these two groups regarding sex, initial body weight, previous TB disease, hospital admission, diabetes mellitus, end-stage renal disease, neoplasm, liver cirrhosis, upper lung field involvement, cure, and treatment completion. Furthermore, age of 60 and older, lower initial body weight less than 50 kg, coexisting medical diseases, and extensive radiographic disease were factors independently associated with unfavorable outcomes. Elderly patients with pulmonary TB are more likely to present with negative sputum smears, cavity-negative lesions, lower lung field involvement and pleural effusion on chest radiographs. The prognosis is poor for the elderly pulmonary TB patients with lower body weight, coexisting medical diseases, and extensive radiographic disease.

Diagnostic challenge of tuberculosis of the elderly in hospital: Experience at a University Hospital in Saudi Arabia

We studied retrospectively 80 elderly patients who had been admitted to hospital with tuberculosis (TB) between January 1988 and June 1993. There were 64 with pulmonary TB and 16 with miliary tuberculosis (MTB). The mean age was 70+/-7.5 years (range 60-88 years) with 56% over 70 years of age. Underlying disease preceding TB was present in 86.3% patients. In the majority of patients clinical manifestations were subtle. Chest X-ray showed involvement of lower lung fields and miliary shadowing in 71.2% (33/80) and 20% (16/80) patients, respectively. The organism was detected in expectorated sputum specimens in 62.5% (50/80). Of the specimens obtained by flexible fibreoptic bronchoscopy (FOB), 61% were positive for acid-fast bacilli (AFB) by films and culture. Drug-induced adverse effects were observed in 17.6% (6/34). In 18 patients (22.5%), the diagnosis of TB was delayed or missed. The overall mortality of 21% (9/43) included seven patients with MTB and two with pulmonary TB. TB was the direct cause of death in the former and a significant contributory cause in the latter.

Lower-Lung-Field Tuberculosis in Saudi Arabia

One hundred sixty-one patients were found to have lower-lung-field tuberculosis in a retrospective study of 1566 cases of pulmonary tuberculosis admitted to Sahary Chest Hospital, Riyadh. This repr...