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Effects of diabetes mellitus on the clinical presentation and treatment response in tuberculosis
Author(s) -
Leung Chi C.,
Yew Wing W.,
Mok Thomas Y.W.,
Lau Kam S.,
Wong Chi F.,
Chau Chi H.,
Chan Chi K.,
Chang Kwok C.,
Tam Greta,
Tam Cheuk M.
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13017
Subject(s) - medicine , tuberculosis , sputum , diabetes mellitus , incidence (geometry) , isoniazid , rifampicin , sputum culture , adverse effect , surgery , pediatrics , pathology , physics , optics , endocrinology
Background and objective With the colliding global epidemics of diabetes mellitus ( DM ) and tuberculosis ( TB ), we studied the effects of DM on the presentation of TB and its response to treatment. Methods Consecutive TB patients from 2006 to 2010 in a territory‐wide treatment programme offering 9‐month extended treatment for TB patients with DM were examined and followed up prospectively to assess their treatment response. Successful treatment completers were tracked through the TB registry and death registry for relapse, death or till 31 December 2014, whichever was the earliest. Results DM was independently associated with more chest symptoms (adjusted OR ( AOR ): 1.13) and systemic symptoms ( AOR : 1.30) but less with other site‐specific symptoms ( AOR : 0.58) at TB presentation. There was more frequent pulmonary involvement ( AOR : 1.69), with more extensive lung lesion ( AOR : 1.25), lung cavity ( AOR : 2.00) and positive sputum smear ( AOR : 1.83) and culture ( AOR : 1.38), but no difference in the proportion of retreatment cases or isoniazid and/or rifampicin resistance. After treatment initiation, there was higher overall incidence ( AOR : 1.38) of adverse effects (mainly gastrointestinal symptoms, renal impairment and peripheral neuropathy but less fever and skin hypersensitivity reactions), more smear non‐conversion ( AOR : 1.59) and culture non‐conversion ( AOR : 1.40) at 2 months, and lower combined cure/treatment completion rate at 12 months ( AOR : 0.79), but no difference in the relapse rate after having successfully completed treatment. Conclusion DM adversely affected the clinical presentation and treatment response of TB , but there was no difference in the drug resistance and relapse rates.