Clinicoradiological Presentation of Pulmonary Tuberculosis in Patients with Diabetes Mellitus at a Tertiary Care Hospital.

The relationship between TB and DM has been debated. Experts are concerned about the convergence of TB and diabetes epidemics, particularly in low- to middle-income countries like India and China, which have the world's highest TB burden and fastest rising diabetes prevalence. Diabetes mellitus may be related to the rise in TB cases in India. We discuss TB epidemiology, clinical features, microbiology, imaging, treatment, and prognosis.
Material: The data was gathered from out-patients and medical ward patients at B.R. Ambedkar Medical College under NTEP and would be used in this research based on inclusion and exclusion criteria. The patient/attendant gave written informed consent. A comprehensive clinical history, physical examination, and appropriate investigations were performed.
Study Design: Prospective, observational study.
Sample Size: 50. Study place: Department Of General Medicine And Department Of Chest Medicine.
Inclusion Criteria: Age group >18 years. Sputum positive and sputum negative cases. Clinical diagnosed diabetes both naive and on treatment.
Exclusion Criteria: Age group < 18 years. Pregnant women. Immunocompromised states (HIV positive, Long-term corticosteroid, chemotherapy, post transplant patients, associated oncological disorders).
Observation: The research group had 60% men and 40% females, a 3:2 male to female ratio. 80% of patients were over 40, and 66% were from low socioeconomic backgrounds. Cough with expectoration (90%) was the most common symptom, followed by weight loss (32%), fever (30%), and hemoptysis (4%). Our study's participants comprised 46% smokers and 10% alcoholics. The group had diabetes for an average of 5.4 years and 58 percent had clubbing and 30% had Pallor. The research group's average fasting and postprandial blood sugars were 220.5 and 302.7 mg/dl. The study's HbA1c averaged 9.3. 50% of individuals had lower zone involvement and 36% had middle lung field TB. In 46% of patients, the right side was affected, 44% the left, and 10% had bilateral TB. Infiltrations (50%) and Cavitary lesions (30%) were the most frequent results, with multiple cavities (64.3%). Patients with greater HbA1c (>8%) had more cavities.
Conclusion: All patients with pulmonary tuberculosis should be screened for diabetes mellitus and should be effectively treated for the same. Patients with coexisting pulmonary tuberculosis and diabetes mellitus have atypical presentations. Chest radiographs of such patients show multiple cavitations with predominant lower lobe involvement. Pulmonary Tuberculosis patients who have diabetes tend to have higher sputum positivity rates and delayed sputum conversion if glycemic levels are poorly controlled.
(© Journal of the Association of Physicians of India 2011.)