Screening for tuberculosis in a diabetes clinic in Gaborone, Botswana

Reid, Michael; Oyewo, Aderonke; Molosiwa, Bodney; McFadden, Nikia R; Tsima, Billy; Ho-Foster, Ari

doi:10.5588/ijtld.14.0178

Cited by 6 publications

(11 citation statements)

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“…In Africa, studies investigating the prevalence of TB among persons with DM are limited. The few studies that have been performed show varying prevalence of DM in TB patients, ranging from 3% [12] to 36% [13], more than 5 folds greater than in the general population [14,15]. In Tanzania, 1.3% of screened adults with DM had TB, 7–fold greater than the general population [16].…”

Section: Introductionmentioning

confidence: 99%

TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection

et al. 2019

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BackgroundDiabetes Mellitus (DM) is a known risk factor for tuberculosis (TB) but little is known on TB-Diabetes Mellitus (TBDM) co-morbidity in Sub-Saharan Africa.MethodsConsecutive TB cases registered at a tertiary facility in Ghana were recruited from September 2012 to April 2016 and screened for DM using random blood glucose and glycated hemoglobin (HbA1c) level. TB patients were tested for other clinical parameters including HIV co-infection and TB lesion location. Mycobacterial isolates obtained from collected sputum samples were characterized by standard methods. Associations between TBDM patients’ epidemiological as well as microbiological variables were assessed.ResultsThe prevalence of DM at time of diagnosis among 2990 enrolled TB cases was 9.4% (282/2990). TBDM cases were significantly associated with weight loss, poor appetite, night sweat and fatigue (p<0.001) and were more likely (p<0.001) to have lower lung cavitation 85.8% (242/282) compared to TB Non-Diabetic (TBNDM) patients 3.3% (90/2708). We observed 22.3% (63/282) treatment failures among TBDM patients compared to 3.8% (102/2708) among TBNDM patients (p<0.001). We found no significant difference in the TBDM burden attributed by M. tuberculosis sensu stricto (Mtbss) and Mycobacterium africanum (Maf) and (Mtbss; 176/1836, 9.6% and Maf; 53/468, 11.3%, p = 0.2612). We found that diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mtbss (odds ratio (OR) = 1.52; 95% confidence interval (CI): 0.92–2.42, p = 0.072).ConclusionOur findings confirms the importance of screening for diabetes during TB diagnosis and highlights the association between genetic diversity and diabetes. in Ghana.

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Section: Introductionmentioning

confidence: 99%

TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection

et al. 2019

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“…Studies investigating the prevalence of TB among persons with DM in the SSA context are limited [16] , [17] , [18] . In Tanzania, 1.3% of screened adults with DM had TB, 7–fold greater than the general population [16] .…”

Section: Introductionmentioning

confidence: 99%

The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting

Berkowitz

Okorie

Goliath

et al. 2018

Diabetes Research and Clinical Practice

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HighlightsFirst in Africa to screen all DM patients for TB (irrespective of symptoms using Xpert) and HIV.Study found high prevalence of TB in DM patients, over half of whom were asymptomatic.HIV prevalence was 13% in DM patients, showing importance of HIV screening this older population.DM patients with HIV or hemoptysis at greater TB risk, and should be targeted for active TB case-finding.Given high subclinical active TB prevalence, screening should be irrespective of symptoms in this group.

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“…Challenges such as the need to travel to other facilities for diagnostic testing could be addressed by provision of a one-stop service for diagnosis (chest x-ray and sputum examination) in high TB burden settings. 35,41 Where available, tests for M. tuberculosis infection could be used and preventive treatment considered. 42 Furthermore, a chronic disease approach is recommended, whereby chest x-ray can be used to screen for diseases such as heart failure when done on patients suspected of having TB.…”

Section: Discussionmentioning

confidence: 99%

Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa

Alisjahbana

McAllister

Ugarte-Gil

et al. 2020

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.

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Screening for tuberculosis in a diabetes clinic in Gaborone, Botswana

Cited by 6 publications

References 0 publications

TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection

TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection

The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting

Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa

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