Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital

Abstract

BackgroundTuberculosis is one of the major infectious diseases in Taiwan. It has an especially high prevalence in diabetes patients, in whom it is usually asymptomatic and are more likely to result in drug-resistant tuberculosis. The aim of the study was to aggressively screen high risk diabetic elderly, identify the prevalence of tuberculosis and its determinants.MethodsType 2 diabetes patients aged over 65 years were enrolled. They received chest X-rays, blood tests and the questionnaires to assess their medical history and symptoms. Suspicious cases were referred to the pulmonary or infectious disease outpatient clinics. Pulmonary tuberculosis was confirmed by sputum culture. Variables between groups were analyzed by Student t test, Chi-square test or Fisher’s exact test. Risk factors were assessed using univariate logistic regression and multiple logistic regression.ResultsA total of 3,087 patients participated this screening program and 7 patients screened positive for pulmonary tuberculosis. Another 5 patients were being under treatment when participating screening program. The prevalence rate was 3.89 per thousand people. The patients with male gender, smoking, liver cirrhosis or subjective body weight loss were associated with an increased risk of tuberculosis significantly. Subjective body weight loss (OR: 6.635 [95% CI: 2.096-21.007]), liver cirrhosis (OR: 10.307 [95% CI: 2.108-50.395]) and history of smoking (OR: 3.981 [95% CI: 1.246-12.718]) are independent risk factors. Among all 73 patients with active tuberculosis or tuberculosis history, they tended to be male, lower body mass index (BMI), more smoking history, more alcohol consumption, more family history of tuberculosis, higher low density lipoprotein (LDL), and less hypertension. However, there was no significant difference in the glycated hemoglobin (HbA1c) levels between the tuberculosis group and non-tuberculosis group.ConclusionsActive screening program is helpful in detecting pulmonary tuberculosis in elderly diabetes patients. Subjective body weight loss, smoking and liver cirrhosis are independent risk factors.

Incident rate and risk factors for tuberculosis among patients with type 2 diabetes: retrospective cohort study in Shanghai, China

“…An early cohort study using the 1971–1975 national survey as the baseline assessment observed that the TB incident rate increased inversely with body weight among adults from the general population; the adjusted hazard ratios were 12.43, 1.00 (reference), 0.28 and 0.20, for adults with underweight, normal weight, overweight and obesity respectively after controlling for demographic, socioeconomic and medical characteristics . Our study extends the observation from the general population to the population with diabetes, and observations from older populations with diabetes to relative young populations with diabetes. Underweight, defined as BMI <18.5 kg/m 2 , is a well‐established marker of malnutrition and has been linked to an increased susceptibility to develop tuberculosis biologically and epidemiologically , especially in low‐ and middle‐income countries .…”

An adverse immune-endocrine profile in patients with tuberculosis and type 2 diabetes

“…This profile of immune-endocrine alterations, reported here for the first time, is likely to bear a close relation with the patient condition and the physiopathological mechanisms underlying the development of the disease. For example, the increased BMI which was seen in diabetic patients [28] was not present when they also have TB.…”

To Study Clinical Profile of Tuberculosis in Patients of Diabetes Mellitus

“…Total cholesterol level is significantly lower in tubercular group. (p<0.05) Accumulating literatures have described the difference in lipid profiles between TB and health controls, showing lower levels of total cholesterol, LDL, and highdensity lipoprotein level in TB cases Some authors speculated that it might be the result of increased lipid metabolism during inflammatory or infection status for immune response (14) . There was no difference in liver function test between tubercular and non tubercular group.…”