No abstract

Diabetic people are considered to be high-risk patients for developing pulmonary tuberculosis (PTB). Usually, PTB found predominantly in the upper lobes may be unilateral, bilateral, both upper and lower lobe involvement, cavities, effusion, or any combinations of them. Isolated lower lung field tuberculosis occurs but it often misdiagnosed as pneumonia, carcinoma, and lung abscess. A number of published comparative studies found chest X-ray images from PTB with diabetes (DM) have been described as atypical because they frequently involve the lower lung field often with cavities.METHODS: ON this cross-sectional comparative study, we studied 117 patients with PTB proven by their sputum AFB, /Culture, /Gene Xpert MTB/Rif and DM which is proven by taking oral hypoglycemic drugs or receiving insulin at the time of hospital admission or FPG $126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h. OR 2-h PG$200mg/dL (11.1mmol/L) during OGTT. OR A1C $6.5% (48 mmol/L). . OR in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, random plasma glucose $200 mg/dL (11.1 mmol/L). In the absence of unequivocal hyperglycemia, results were confirmed by repeat testing. Another 50 patients were later enrolled with PTB but non-diabetic as control. Extrapulmonary TB without pulmonary involvement and seropositive HIV is excluded to allow better Data comparison. All patients will undergo a chest x-ray to see the frequency of lower lung field Tuberculosis among TB with coexisting diabetes (DM) patients. RESULTS:A total of 117 TB DM patients of which frequency of lower lung field TB was 20.5%, majority of them belonged to age 41-60 years. Males were predominant with a male-female ratio of 3:1. The comparison of the frequency of lower lung field TB and other radiological forms among different age groups, smear positivity(83.3% vs 20.4%), ESR >50mm in 1st hr(95.8% vs 16.1%), and HbA1c <7%(79.2% vs 16.!%) found statistically significant p-value <0.05 and among duration of diabetes(<10 years), smoking history, smoking duration, relation with treatment profile and MDR TB was not found statistically significant p-value > 0.05. Another 50 non-diabetic PTB patients were included later in this study as control and multivariate analysis was done to exclude any confounding role of age(>40 years) over diabetes, and found p-value for diabetes and age 0.012 and 0.035 and OR was 6.809 and 3.928. So it can finally conclude Diabetes is an independent risk factor for developing lower lung field tuberculosis.CONCLUSIONS: Frequency of lower lung field TB among TB DM patients are around 1/5 th so during investigation of DM patient, care must be taken no to miss this atypical radiological pattern of tuberculosis and treatment should be started as early as possible to reduce morbidity and mortality.CLINICAL IMPLICATIONS: This study may be repeated with a larger sample size with a case-control design The HIV status of the patient should be seen to exclude its confounding role

<p class="Abstract">A 17 year old girl visited several physicians with the complaints of upper central chest pain for eight months. She was finally diagnosed as upper thoracic (third thoracic vertebra) tuberculous spondylitis. The diagnosis was probably delayed for its unusual site of presentation and delayed onset of constitutional features like fever, anorexia and weight loss.</p>