Extensive Radiological Manifestation in Patients with Diabetes and Pulmonary Tuberculosis: A Cross-Sectional Study

Abstract

Background: Diabetes mellitus (DM) is believed to affect tuberculosis (TB) at multiple levels in disease control and treatment efficacy, but clinical and radiological presentation resulting from interaction of the two diseases is not known. Methods: A cross-sectional study was conducted on data obtained from medical records of 438 patients confirmed with TB-DM comorbidity at the Third people's hospital of Shenzhen from May 01, 2014, to April 30, 2019. Their CT images were reviewed, and patients were divided into subgroups according to lung cavitation: with and without cavities, and number of segments showing pulmonary infiltration: <4 segment, 4-8 segment, >8 segment infiltrates. We then compared clinical parameters between these groups. Results: The median age of the patients was 50.0 years (IQR 43.3-56.0) and 86% (n=375) of them were male. Pulmonary cavities were found in 80.8% patients. About 42.7% and 27.2% patients were seen to have infiltration involving 4-8 and >8 lung segments, respectively. Patients presented with cavitation and infiltration involving a greater number of lung segments had significantly higher values of WBC, MONO%, GRA%, CRP, lower LYN% level and higher bacterial burden in sputum (P<0.001). Higher HbA1c and FBG were only observed in patients with lung cavities (P<0.001). There was no difference in positive ELISPOT.TB and PCT level between the groups regardless of presence or absence of lung cavity (P>0.9 and P=0.1 respectively). Lower HGB, ALB and higher PCT were observed in patients with infiltration involving more lung segments. Conclusion: Hyper-inflammation in peripheral blood was significantly associated with cavity and the number of lung lesions. Hyperglycemia was significantly associated with the development of lung cavity. Glycemic control and inflammation influenced radiographic manifestations in patients with TB-DM.

Impact of hyperglycemia on tuberculosis treatment outcomes: a cohort study

“…Previous studies have shown that patients with TB with hyperglycemia presented with cavities, alveolar infiltrates, and fibrous tracts more frequently than those with normoglycemia 6 , 37 . However, the results of this study are contrary, and no significant effect of hyperglycemia on pulmonary lesions in patients with TB was found after controlling for confounding factors.…”

Computed tomography findings in patients with pulmonary tuberculosis and diabetes at an infectious disease hospital in China: a retrospective cross-sectional study

“…There are many studies [ 8 , 9 , 17 , 26 ] suggesting that TB-DM patients have lesions primarily in the lower lungs and involving more lobes. In contrast, our results showed no statistical difference between the TB-DM and DM groups in terms of the location of the TB lesions.…”

The association between type 2 diabetes and pulmonary cavitation revealed among IGRA-positive tuberculosis patients

“…Two experienced radiologists reviewed the CT images and reached a consensus decision at the Third People's Hospital of Shenzhen. The definition of pulmonary cavitation can be referred in this article ( 3 ), and a representative CT image is displayed in Supplementary Figure 1 .…”

“…Diabetes, as a metabolic disorder disease, is associated with innate and adaptive immune dysfunctions and alterations in specific cytokines and chemokines (2). Previous studies have reported a paradoxical hyperinflammatory response in TB patients with DM, such as IFN-γ, IL-2, and TNF-a (3)(4)(5). There were studies indicating that diabetes mellitus (DM) is associated with an increased risk of TB (6)(7)(8).…”