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Respiratory Care |

Tuberculosis With Diabetes Mellitus: Does Delayed Sputum Conversion Always Needs MDR Evaluation?

Patil Shital, MBBS; Swati Narwade, MBBS
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Maharashtra Institute of Medical Sciences and Research, Medical College Latur, Latur, India


Chest. 2014;146(4_MeetingAbstracts):918A. doi:10.1378/chest.1991545
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Abstract

SESSION TITLE: Respiratory Infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To study correlation of delayed sputum conversion in cases of PTB (pulmpnary TB) with DM as that of without DM, and also to assess whether DM increases potential threat towards MDR TB.

METHODS: Methods-Prospective study conducted at MIMSR Medical College Latur, India during Jan. 2011 to Nov. 2013 included 200 cases of Diabetes Mellitus (DM) with TB, compared with 200 cases of TB without DM. Objectives of study were to correlate impact of DM on sputum conversion rate and on clinic-radiological overlap of DM and PTB. Sputum smear AFB examinations were done at diagnosis and subsequently at completion of intensive phase. Liquid Culture DST (MGIT-960) were done in all the cases those doesn’t showing sputum conversion even after extension of one month therapy post-intensive phase. statistical analysis was done using chitest.

RESULTS: Results- PTB was observed in 141 (70.5%) cases with DM as compared to 173 (86.5%) cases without DM (p<0.0002).Lower Lung fields involvement in 34 (24.11%) cases with DM and 11 (6.35%) cases without DM cases. Pulmonary Cavities were observed in 55 (39.00%) cases with DM and 49 (28.32%) cases without DM (p<0.0001). Sputum conversion percentage was observed in 76.53% DM group as compared to without DM group 92.70% (p<0.003). Out of 5.2% cases which were failed to show sputum conversion in diabetic group, 2.8% cases were found to have MDR TB.

CONCLUSIONS: Conclusion- DM affects the clinical, bacteriological and radiological presentation of PTB. Failure of sputum conversion should be interpreted cautiously, as many cases were showing delayed sputum conversion after extension of one month of intensive phase; this may be because of generalized immunosupression due to underlying comorbidity of DM.

CLINICAL IMPLICATIONS: Sputum conversion at the end of Intensive phase is delayed in DM cases. It doent means always a marker of MDR as many cases were showing sputum conversion after one month treatment of completion of intensive phase. DOTS has similar outcome in form of treatment success irrespective of diabetes mellitus. Although MDR evaluation is mandatory in those cases not showing sputum conversion at the end of intensive phase in cases without DM, it should be done cautiously in DM cases. We observed that sputum conversion was observed in proportionate number of cases after one month treatment of completion of intensive phase, and it would decrease cost of MDR evaluation in those cases of TB with DM especially in high burden countries like India.

DISCLOSURE: The following authors have nothing to disclose: Patil Shital, Swati Narwade

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