Chest Infections: Chest Infections |

A Comparison of Clinical, Radiological, and Bacteriological Characteristics of Pulmonary Tuberculosis in Diabetic and Non-Diabetic Patients FREE TO VIEW

Mohammad Hossain, MD; Jamal Ahmed, MBBS; Farhana Afroz, MBBS
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Birdem General Hospital, Dhaka, Bangladesh

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A73. doi:10.1016/j.chest.2016.02.078
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SESSION TITLE: Chest Infections

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Diabetes Mellitus (DM) may influence the clinical features, radiological involvement and sputum smear positivity rate of pulmonary tuberculosis (PTB). The aim of this study was to see the clinical, radiological and bacteriological features of PTB in DM patients compared to non-diabetic (non-DM) patients.

METHODS: This cross-sectional study was performed from July 2013 to June 2015 in the Department of Internal Medicine and Pulmonology of BIRDEM General Hospital as part of BADAS-USAID TB Care-II project, Bangladesh. Out of 7165 TB suspects, 1014 (14.2%) were confirmed as TB cases; of them 694 (68.4%) were diagnosed as PTB and were included in the study.

RESULTS: Out of 694 PTB patients, 606 (87.3%) were diabetic and 88 (12.7%) were non-diabetic. Most of the patients in both groups (71.1% DM vs 63.6% non-DM) were male. Compared to non-DM patients, patients with DM were older (Mean age 48.7±12.4 vs 36.4±17.0; p=0.015] and had increased body mass index (BMI) (Mean BMI 20.0±3.7 vs 18.4±3.3; p=0.003). There was no significant difference in the clinical features of PTB (fever 96.4% vs 94.3%, cough 92.0% vs 95.5%, weight loss 87.8% vs 85.2% respectively) between DM and non-DM patients. Compared to non-DM patients, cavitary lesion (26.7% in DM vs 8.0% in non-DM) and lower-lobe opacity (28.3% in DM vs 14.9% in non-DM) in chest x-ray were more in diabetics whereas apical opacity (1.7% in DM vs 5.7% in non-DM) and pleural effusion (9.3% in DM vs 12.6% in non-DM) was more in non-DM [p=0.000]. Most of the DM patients (60.1%) had sputum smear positive PTB while non-DM patients (66.7%) had smear negative PTB. Gene x-pert MTB/RIF was positive more in DM patients (93.7% vs 88.6%) [p=0.05].

CONCLUSIONS: Diabetic patients with PTB are comparatively older, have increased body weight, are more sputum smear positive and have atypical radiological involvement.

CLINICAL IMPLICATIONS: Atypical chest x-ray in a pulmonary tuberculosis patient can hint to co-existing diabetes mellitus.

DISCLOSURE: The following authors have nothing to disclose: Mohammad Hossain, Jamal Ahmed, Farhana Afroz

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