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Variation in Pulmonary Tuberculosis Presentation Among Diabetics FREE TO VIEW

John Kileci, MD; Henry Dinneen, DO; Alfred Lardizabal, MD
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Rutgers New Jersey Medical School, Newark, NJ

Chest. 2015;148(4_MeetingAbstracts):144A. doi:10.1378/chest.2225490
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SESSION TITLE: Chest Infections Posters: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study is to evaluate differences in clinical presentation, tuberculosis (TB) culture conversion times, and initial presentation of smears in diabetic patients with pulmonary tuberculosis compared to patients without diabetes.

METHODS: We performed a retrospective chart review of diabetic patients with primary pulmonary tuberculosis (PTB) seen between 2005-2014 in Newark, NJ. Our cohort was gathered using ICD-9 diagnoses codes. The clinical sites were both the University Hospital and the Lattimore Global Tuberculosis Institute. Patients were all above the age of 18. HIV (+) patients were excluded from the study. Patients' initial TB presentations were the primary focus; TB culture conversion times, initial presentation on smears and drug resistance were all studied. Also, we analyzed chest xrays performed within 2 months of the initial diagnosis of pulmonary TB and HgbA1c values obtained within 3 months of diagnosis. A standardized scale classifying lung involvement and extent of cavitation was used to grade the initial CXR presentations.

RESULTS: 149 patients with both DM and TB (TBDM) were identified, of which only 38 patients fit our study criteria. 55 patients with primary pulmonary TB without diabetes (PTB) were identified. The HgbA1c mean was 9.06 g/dl. 17 patients in the TBDM group had extensive disease involving both lungs; areas other than upper lung fields, pleural effusions involving TB and bone involvement. 21% (8/38) of patients had drug resistant TB in the TBDM group whereas only 5.45% (3/39) of patients in the PTB group had resistance to drugs. The TBDM group had 72.1% moderate to severe involvement on CXR (i.e. bilateral, thoracic cavity involvement size), whereas 37.3% of patients in the PTB group had same extent of severity. 46.5% of TBDM group had large and numerous cavitations and only 27.3% in the PTB group had a cavitary lesion to that extent. The average day to conversion was 66.89 days among the 19 patients studied in TBDM group and it was 47.65 days among the 32 patients in the PTB group. 28% (7/25) of TBDM patients had 4+ and 3+ presentations on smears, whereas 24.3% (9/37) of patients in the PTB group had the same extent of presentation on smears.

CONCLUSIONS: In our cohort, patients with TB and DM had worse presentation clinically, radiographically and had slower conversion rates compared with TB only patients.

CLINICAL IMPLICATIONS: Aggressive diabetes management has to be part of TB management given its clinical implications on TB disease progression and severity.

DISCLOSURE: The following authors have nothing to disclose: John Kileci, Henry Dinneen, Alfred Lardizabal

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