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Bermúdez-Hernández GA, Pérez-Martínez D, Ortiz-León MC, Muñiz-Salazar R, Licona-Cassani C, Zenteno-Cuevas R. Mutational Dynamics Related to Antibiotic Resistance in M. tuberculosis Isolates from Serial Samples of Patients with Tuberculosis and Type 2 Diabetes Mellitus. Microorganisms 2024; 12:324. [PMID: 38399727 PMCID: PMC10892438 DOI: 10.3390/microorganisms12020324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
Genetic variation in tuberculosis is influenced by the host environment, patients with comorbidity, and tuberculosis-type 2 diabetes mellitus (TB-T2DM) and implies a higher risk of treatment failure and development of drug resistance. Considering the above, this study aimed to evaluate the influence of T2DM on the dynamic of polymorphisms related to antibiotic resistance in TB. Fifty individuals with TB-T2DM and TB were initially characterized, and serial isolates of 29 of these individuals were recovered on day 0 (diagnosis), 30, and 60. Genomes were sequenced, variants related to phylogeny and drug resistance analyzed, and mutation rates calculated and compared between groups. Lineage X was predominant. At day 0 (collection), almost all isolates from the TB group were sensitive, apart from four isolates from the TB-T2DM group showing the mutation katG S315T, from which one isolate had the mutations rpoB S450L, gyrA A90G, and gyrA D94G. This pattern was observed in a second isolate at day 30. The results provide a first overview of the dynamics of mutations in resistance genes from individuals with TB-T2DM, describing an early development of resistance to isoniazid and a rapid evolution of resistance to other drugs. Although preliminary, these results help to explain the increased risk of drug resistance in individuals with TB and T2DM.
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Affiliation(s)
- Gustavo A. Bermúdez-Hernández
- Biomedical Sciences Doctoral Program, Institute of Health Sciences, University of Veracruz, Xalapa 91190, Veracruz, Mexico;
| | - Damián Pérez-Martínez
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
| | - Maria Cristina Ortiz-León
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
| | - Raquel Muñiz-Salazar
- School of Health Sciences, Autonomous University of Baja California, Ensenada 22860, Baja California, Mexico;
| | - Cuauhtemoc Licona-Cassani
- Monterrey Institute of Technology, School of Engineering and Sciences, Monterrey 64700, Nuevo León, Mexico;
| | - Roberto Zenteno-Cuevas
- Institute of Public Health, University of Veracruz, Xalapa 91190, Veracruz, Mexico; (D.P.-M.); (M.C.O.-L.)
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Majaliwa ES, Muze K, Godfrey E, Byashalira K, Mmbaga BT, Ramaiya K, Mfinanga SG. Latent tuberculosis in children and youth with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a cross section survey. BMC Infect Dis 2023; 23:740. [PMID: 37904143 PMCID: PMC10614349 DOI: 10.1186/s12879-023-08753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Data for latent tuberculosis in patients with type 1 Diabetes in Africa is limited. We assessed the prevalence of latent tuberculosis in youth and children with type 1 Diabetes in Dar es Salaam -Tanzania. METHODS Our cross-sectional study recruited children and youth with T1DM by stage of puberty, glycaemic control, and age at diagnosis from January to December 2021 in Dar es Salaam. Participants were screened for the presence of latent Tuberculosis using the QuantiFERON test. A positive test was considered to have latent TB. RESULTS Of the 281 participants, the mean age was 19 (± 6) years, 51.2% were female, and 80.8% had either a primary or secondary level of education at baseline. The prevalence of latent TB was 14.9% and was slightly higher in females (52.4%) than in males. This difference, however, was insignificant (p > 0.05). On the other hand, the proportion of latent TB was significantly higher in uncontrolled HbA1c levels (76.2%) than in those with controlled HbA1c (23.8%) [p = 0.046]. Duration of diabetes and age at diagnosis did not affect the occurrence of latent Tuberculosis [p > 0.05]. Meanwhile, in the regression model, participants with latent TB were more likely to have uncontrolled HbA1c. [p = 0.045] CONCLUSIONS: Despite the methodological limitations, this survey highlights the high prevalence of latent TB among children and youth with diabetes; shouting for better control. These results clearly show the need to screen for Tuberculosis in children and youth with diabetes and start them on prevention as per protocol, especially in tuberculosis-endemic areas like Tanzania.
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Affiliation(s)
- Edna S Majaliwa
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania.
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania.
| | - Kandi Muze
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Kenneth Byashalira
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, Siha, United Republic of Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- School of Public Health, Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Alliance for Africa Research and Innovation, Dar es Salaam, United Republic of Tanzania
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Rendón Ramírez EJ, Rosas-Taraco AG, Soto-Monciváis B, Colunga-Pedraza PR, Salazar-Riojas R, Méndez-Ramírez N, Arce-Mendoza AY, Muñiz-Buenrostro A, Llaca-Díaz J, Gomez-Almaguer D, Rendón A. Comparison of CD4+/CD8+ Lymphocytic Subpopulations Pre- and Post-Antituberculosis Treatment in Patients with Diabetes and Tuberculosis. Pathogens 2023; 12:1181. [PMID: 37764989 PMCID: PMC10536186 DOI: 10.3390/pathogens12091181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Is there a CD4+ and CD8+ immunity alteration in patients with pulmonary tuberculosis (TB) and diabetes (DM) that does not recover after antituberculosis treatment? This prospective comparative study evaluated CD4+ and CD8+ lymphocytic subpopulations and antituberculosis antibodies in patients with diabetes and tuberculosis (TB-DM), before and after antituberculosis treatment. CD4+ T cell counts were lower in patients with TB-DM compared to those with only TB or only DM, and these levels remained low even after two months of anti-TB treatment. Regarding the CD8+ T cell analysis, we identified higher blood values in the DM-only group, which may be explained by the high prevalence of latent tuberculosis (LTBI) in patients with DM. IgM antituberculosis antibodies levels were elevated in patients with only TB at baseline, and 2 months post-anti-TB treatment, IgG did not express any relevant alterations. Our results suggest an alteration in CD4+ immunity in patients with TB-DM that did not normalize after antituberculosis treatment.
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Affiliation(s)
- Erick J. Rendón Ramírez
- Servicio de Neumología y Medicina Crítica, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Adrián G. Rosas-Taraco
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Berenice Soto-Monciváis
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Perla R. Colunga-Pedraza
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Rosario Salazar-Riojas
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Nereida Méndez-Ramírez
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Alma Yolanda Arce-Mendoza
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Antonio Muñiz-Buenrostro
- Departamento de Inmunología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Jorge Llaca-Díaz
- Departamento de Patología Clínica, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - David Gomez-Almaguer
- Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (P.R.C.-P.)
| | - Adrián Rendón
- Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias (CIPTIR), Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
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Houck K, Chakhaia T, Gorvetzian S, Critchley JA, Schechter MC, Magee MJ. Diabetes Mellitus and Tuberculosis Treatment Outcomes: Interaction Assessment Between Hyperglycemia and Human Immunodeficiency Virus in the State of Georgia, 2015-2020. Open Forum Infect Dis 2023; 10:ofad255. [PMID: 37383249 PMCID: PMC10295156 DOI: 10.1093/ofid/ofad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023] Open
Abstract
Background Diabetes mellitus and human immunodeficiency virus (HIV) are independent risk factors for poor outcomes among people with tuberculosis (TB). To date, information on the joint impact of diabetes and HIV on TB outcomes is limited. We aimed to estimate (1) the association between hyperglycemia and mortality and (2) the effect of joint exposure to diabetes and HIV on mortality. Methods We conducted a retrospective cohort study among people with TB in the state of Georgia between 2015 and 2020. Eligible participants were 16 or older, did not have a previous TB diagnosis, and were microbiologically confirmed or clinical cases. Participants were followed during TB treatment. Robust Poisson regression was used to estimate risk ratios for all-cause mortality. Interaction between diabetes and HIV was assessed on the additive scale using the attributable proportion and on the multiplicative scale with product terms in regression models. Results Of 1109 participants, 318 (28.7%) had diabetes, 92 (8.3%) were HIV positive, and 15 (1.4%) had diabetes and HIV. Overall, 9.8% died during TB treatment. Diabetes was associated with an increased risk of death among people with TB (adjusted risk ratio [aRR] = 2.59; 95% confidence interval [CI], 1.62-4.13). We estimated that 26% (95% CI, -43.4% to 95.0%) of deaths among participants with diabetes mellitus and HIV were due to biologic interaction. Conclusions Diabetes alone and co-occurring diabetes and HIV were associated with an increased risk of all-cause mortality during TB treatment. These data suggest a potential synergistic effect between diabetes and HIV.
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Affiliation(s)
- Kennedy Houck
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tsira Chakhaia
- Department of Population Health Sciences, Georgia State University, Atlanta, Georgia, USA
| | - Sarah Gorvetzian
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Julia A Critchley
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Georgia Department of Public Health Tuberculosis Program, Atlanta, Georgia, USA
| | - Matthew J Magee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Verma A, Kaur M, Luthra P, Singh L, Aggarwal D, Verma I, Radotra BD, Bhadada SK, Sharma S. Immunological aspects of host-pathogen crosstalk in the co-pathogenesis of diabetes and latent tuberculosis. Front Cell Infect Microbiol 2023; 12:957512. [PMID: 36776550 PMCID: PMC9909355 DOI: 10.3389/fcimb.2022.957512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Diabetes is a potent risk factor for the activation of latent tuberculosis and worsens the tuberculosis (TB) treatment outcome. The major reason for mortality and morbidity in diabetic patients is due to their increased susceptibility to TB. Thus, the study was conducted to understand the crosstalk between M. tuberculosis and its host upon latent tuberculosis infection and under hyperglycemic conditions or diabetes. Methods An animal model was employed to study the relationship between latent tuberculosis and diabetes. BCG immunization was done in mice before infection with M. tuberculosis, and latency was confirmed by bacillary load, histopathological changes in the lungs and gene expression of hspX, tgs1, tgs3 and tgs5. Diabetes was then induced by a single high dose of streptozotocin (150 mg/kg body weight). Host factors, like various cytokines and MMPs (Matrix metalloproteinases), which play an important role in the containment of mycobacterial infection were studied in vivo and in vitro. Results A murine model of latent TB was developed, which was confirmed by CFU counts (<104 in the lungs and spleen) and granuloma formation in lungs in the latent TB group. Also, the gene expression of hspX, tgs1, and tgs5 was upregulated, and after diabetes induction, blood glucose levels were >200 mg/dl. An in vitro study employing a THP-1 macrophage model of latent and active tuberculosis under normal and high glucose conditions showed that dormant bacilli were better contained in the presence of 5.5 mM glucose concentration as compared with active bacilli. However, the killing and restriction efficiency of macrophages decreased, and CFU counts increased significantly with an increase in glucose concentration. Discussion The decreased levels of MCP-1, decreased expression of mmp-9, and increased expression of mmp-1 in the latent group at high glucose concentrations could explain the failure of granuloma formation at high glucose conditions.
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Affiliation(s)
- Arpana Verma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Maninder Kaur
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Princy Luthra
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lakshyaveer Singh
- Tuberculosis Aerosol Challenge Facility (TACF), International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Divya Aggarwal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Verma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan D. Radotra
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna Sharma
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India,*Correspondence: Sadhna Sharma,
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Restrepo BI, Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Loera-Salazar R, Cruz-González A, Caso JA, Joya-Ayala M, García-Oropesa EM, Salinas AB, Martinez L, Schlesinger LS, Torrelles JB, Turner J. Differential Role of Type 2 Diabetes as a Risk Factor for Tuberculosis in the Elderly versus Younger Adults. Pathogens 2022; 11:pathogens11121551. [PMID: 36558885 PMCID: PMC9784720 DOI: 10.3390/pathogens11121551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The elderly are understudied despite their high risk of tuberculosis (TB). We sought to identify factors underlying the lack of an association between TB and type 2 diabetes (T2D) in the elderly, but not adults. We conducted a case-control study in elderly (≥65 years old; ELD) vs. younger adults (young/middle-aged adults (18-44/45-64 years old; YA|MAA) stratified by TB and T2D, using a research study population (n = 1160) and TB surveillance data (n = 8783). In the research study population the adjusted odds ratio (AOR) of TB in T2D was highest in young adults (AOR 6.48) but waned with age becoming non-significant in the elderly. Findings were validated using TB surveillance data. T2D in the elderly (vs. T2D in younger individuals) was characterized by better glucose control (e.g., lower hyperglycemia or HbA1c), lower insulin resistance, more sulphonylureas use, and features of less inflammation (e.g., lower obesity, neutrophils, platelets, anti-inflammatory use). We posit that differences underlying glucose dysregulation and inflammation in elderly vs. younger adults with T2D, contribute to their differential association with TB. Studies in the elderly provide valuable insights into TB-T2D pathogenesis, e.g., here we identified insulin resistance as a novel candidate mechanism by which T2D may increase active TB risk.
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Affiliation(s)
- Blanca I. Restrepo
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Correspondence: (B.I.R.); (J.T.); Tel.: +1-956-279-3841 (B.I.R.)
| | - Julia M. Scordo
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Barshop Institute, The University of Texas Health Science Center of San Antonio, San Antonio, TX 78229, USA
| | | | - Doris Ayala
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Ana Paulina Quirino-Cerrillo
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Raúl Loera-Salazar
- Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
| | - America Cruz-González
- Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
| | - Jose A. Caso
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
| | - Mateo Joya-Ayala
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
- Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
| | - Esperanza M. García-Oropesa
- Unidad Académica Multidisciplinaria Reynosa-Aztlán, Universidad Autónoma de Tamaulipas Reynosa-Aztlán, Reynosa 88779, Mexico
| | - Alejandra B. Salinas
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Larry S. Schlesinger
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Jordi B. Torrelles
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Joanne Turner
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Correspondence: (B.I.R.); (J.T.); Tel.: +1-956-279-3841 (B.I.R.)
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Tireh H, Heidarian Miri H, Khajavian N, Samiei A, Afzalaghaee M. Prevalence of Diabetes Mellitus and its Related Factors in Patients with Tuberculosis. ARCHIVES OF IRANIAN MEDICINE 2022; 25:835-840. [PMID: 37543911 PMCID: PMC10685843 DOI: 10.34172/aim.2022.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/11/2021] [Indexed: 08/08/2023]
Abstract
BACKGROUND Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. METHODS In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. RESULTS The mean age of participants was 51.14±20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR=3.786 (1.183, 12.113), body mass index with OR=9.149 (3.182, 26.302), nationality with OR=2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. CONCLUSION The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality.
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Affiliation(s)
- Hossein Tireh
- Student Research Committee, Mashhad University of Medical Science, Mashhad, Iran
| | - Hamid Heidarian Miri
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasim Khajavian
- Instructor Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Amin Samiei
- Tuberculosis Coordinator at Health Department of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavar Afzalaghaee
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Wu Q, Liu Y, Ma YB, Liu K, Chen SH. Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Ann Med 2022; 54:1657-1666. [PMID: 35703920 PMCID: PMC9225779 DOI: 10.1080/07853890.2022.2085318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The epidemic of type 2 diabetes mellitus (T2DM) poses a great challenge to pulmonary tuberculosis (PTB) control. However, the incidence and prevalence of PTB among T2DM patients has not been fully determined. This meta-analysis aimed to provide the estimation on the global incidence and prevalence of PTB among T2DM patients (T2DM-PTB). METHODS Online databases including Web of Science, PubMed, China National Knowledge Infrastructure and Cochrane Library were searched for all relevant studies that reported the incidence or prevalence of T2DM-PTB through 31 January 2022. Pooled incidence and prevalence of T2DM-PTB with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using R software. RESULTS A total of 24 studies (14 cohort studies, 10 cross-sectional studies) were included. The pooled incidence and prevalence of T2DM-PTB were 129.89 per 100,000 person-years (95% confidence interval (CI): 97.55-172.95) and 511.19 per 100,000 (95% CI: 375.94-695.09), respectively. Subgroup analyses identified that the incidence of T2DM-PTB was significantly higher in Asia (187.20 per 100,000 person-years, 95% CI: 147.76-237.17), in countries with a high TB burden (172.04 per 100,000 person-years, 95% CI: 122.98-240.68) and in studies whose data collection ended before 2011 (219.81 per 100,000 person-years, 95% CI: 176.15-274.28), but lower in studies using International Classification of Diseases-10 codes (73.75 per 100,000 person-years, 95% CI: 40.92-132.91). The prevalence of T2DM-PTB was significantly higher in countries with a high TB burden (692.15 per 100,000, 95% CI: 468.75-1022.04), but lower in Europe (105.01 per 100,000, 95% CI: 72.55-151.98). CONCLUSIONS This systematic review and meta-analysis suggests high global incidence and prevalence of PTB among T2DM patients, underlining the necessity of more preventive interventions among T2DM patients especially in countries with a high TB-burden. Key messagesA total of 24 studies (14 cohort studies, 10 cross-sectional studies) containing 2,569,451 T2DM patients were included in this meta-analysis.The pooled incidence and prevalence of T2DM-PTB are 129.89 per 100,000 person-years (95% CI: 97.55-172.95) and 511.19 per 100,000 (95% CI: 375.94-695.09) respectively.The incidence of T2DM-PTB was significantly higher in Asia, in countries with a high TB burden and in studies whose data collection ended before 2011, but lower in studies using International Classification of Diseases-10 codes.The prevalence of T2DM-PTB was significantly higher in countries with a high TB-burden, but lower in Europe.
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Affiliation(s)
- Qian Wu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yang Liu
- Department of Infectious Diseases Control and Prevention, Jiaxing Center for Disease Control and Prevention, Jiaxing, China
| | - Yu-Bo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Song-Hua Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Essigmann HT, Hanis CL, DeSantis SM, Perkison WB, Aguilar DA, Jun G, Robinson DA, Brown EL. Worsening Glycemia Increases the Odds of Intermittent but Not Persistent Staphylococcus aureus Nasal Carriage in Two Cohorts of Mexican American Adults. Microbiol Spectr 2022; 10:e0000922. [PMID: 35583495 PMCID: PMC9241628 DOI: 10.1128/spectrum.00009-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Numerous host and environmental factors contribute to persistent and intermittent nasal Staphylococcus aureus carriage in humans. The effects of worsening glycemia on the odds of S. aureus intermittent and persistent nasal carriage was established in two cohorts from an adult Mexican American population living in Starr County, Texas. The anterior nares were sampled at two time points and the presence of S. aureus determined by laboratory culture and spa-typing. Persistent carriers were defined by the presence of S. aureus of the same spa-type at both time points, intermittent carriers were S. aureus-positive for 1 of 2 swabs, and noncarriers were negative for S. aureus at both time points. Diabetes status was obtained through personal interview and physical examination that included a blood draw for the determination of percent glycated hemoglobin A1c (%HbA1c), fasting plasma glucose, and other blood chemistry values. Using logistic regression and general estimating equations, the odds of persistent and intermittent nasal carriage compared to noncarriers across the glycemic spectrum was determined controlling for covariates. Increasing fasting plasma glucose and %HbA1c in the primary and replication cohort, respectively, were significantly associated with increasing odds of S. aureus intermittent, but not persistent nasal carriage. These data suggest that increasing dysglycemia is a risk factor for intermittent S. aureus nasal carriage potentially placing those with poorly controlled diabetes at an increased risk of acquiring an S. aureus infection. IMPORTANCE Factors affecting nasal S. aureus colonization have been studied primarily in the context of persistent carriage. In contrast, few studies have examined factors affecting intermittent nasal carriage with this pathogen. This study demonstrates that the odds of intermittent but not persistent nasal carriage of S. aureus significantly increases with worsening measures of dysglycemia. This is important in the context of poorly controlled diabetes since the risk of becoming colonized with one of the primary organisms associated with diabetic foot infections can lead to increased morbidity and mortality.
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Affiliation(s)
- Heather T. Essigmann
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Craig L. Hanis
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - Stacia M. DeSantis
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center, Houston, Texas, USA
| | - William B. Perkison
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - David A. Aguilar
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Goo Jun
- Human Genetics Center, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
| | - D. Ashley Robinson
- Department of Microbiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Eric L. Brown
- Center for Infectious Disease, Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, Texas, USA
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10
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Antonio-Arques V, Franch-Nadal J, Moreno-Martinez A, Real J, Orcau À, Mauricio D, Mata-Cases M, Julve J, Navas Mendez E, Puig Treserra R, Barrot de la Puente J, Millet JP, Del Val García JL, Vlacho B, Caylà JA. Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain). Front Public Health 2022; 10:789952. [PMID: 35677764 PMCID: PMC9168433 DOI: 10.3389/fpubh.2022.789952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis is the leading cause of mortality from lung infectious disease worldwide in recent years, and its incidence has re-emerged in large cities in low-incidence countries due to migration and socioeconomic deprivation causes. Diabetes mellitus and tuberculosis are syndemic diseases, with diabetes being considered a risk factor for developing tuberculosis. Objective To investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain. Methods Observational matched retrospective cohort study based on clinical records from the population of the lowest socioeconomic status in Barcelona (Ciutat Vella district). A cohort including patients with type 1 and type 2 diabetes mellitus in 2007 and new cases until 2016 (8004 subjects), matched 1:1 by sex and age with a non-diabetic cohort. Follow-up period was until December 31st 2018. We evaluated the risk of developing tuberculosis in diabetic patients compared to non-diabetic patients during the follow up period. We used time-to-event analysis to estimate the incidence of tuberculosis, and competing risks regression by clusters and conditional Cox regression models to calculate the hazard ratio (HR) and its 95% confidence intervals (CI). Results Among the 16,008 included subjects, the median follow-up was 8.7 years. The mean age was 57.7 years; 61.2% men and 38.8% women in both groups. The incidence of tuberculosis was 69.9 per 100,000 person-years in diabetic patients, and 40.9 per 100,000 person-years in non-diabetic patients (HR = 1.90; CI: 1.18-3.07). After adjustment for the country of origin, chronic kidney disease, number of medical appointments, BMI, alcoholism and smoking, the risk remained higher in diabetic patients (1.66: CI 0.99-2.77). Additionally, subjects from Hindustan or with a history of alcohol abuse also showed a higher risk of developing tuberculosis (HR = 3.51; CI:1.87-6.57, and HR = 2.73; CI:1.22-6.12 respectively). Conclusion People with diabetes mellitus were at higher risk of developing tuberculosis in a large cohort recruited in an inner-city district with a high incidence for this outcome, and low socioeconomic conditions and high proportion of migrants. This risk was higher among Hindustan born and alcohol abusers.
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Affiliation(s)
- Violeta Antonio-Arques
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Bordeta Magòria, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio Moreno-Martinez
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Real
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Àngels Orcau
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Didac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic—Central University of Catalonia, Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center La Mina, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Josep Julve
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Biochemistry, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Navas Mendez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Rai Puig Treserra
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan Barrot de la Puente
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Doctor Jordi Nadal, Gerència d'Atenció Primària Girona Ciutat, Institut Catala de la Salut, Salt, Spain
| | - Joan Pau Millet
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jose Luis Del Val García
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat d'Avaluació, Sistemes d'informació i Qualitat, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan A. Caylà
- Foundation of the Tuberculosis Research Unit of Barcelona, Barcelona, Spain
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Pérez-Martínez DE, Bermúdez-Hernández GA, Madrazo-Moya CF, Cancino-Muñoz I, Montero H, Licona-Cassani C, Muñiz-Salazar R, Comas I, Zenteno-Cuevas R. SNPs in Genes Related to DNA Damage Repair in Mycobacterium Tuberculosis: Their Association with Type 2 Diabetes Mellitus and Drug Resistance. Genes (Basel) 2022; 13:genes13040609. [PMID: 35456415 PMCID: PMC9029044 DOI: 10.3390/genes13040609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
Genes related to DNA damage repair in Mycobacterium tuberculosis are critical for survival and genomic diversification. The aim of this study is to compare the presence of SNPs in genes related to DNA damage repair in sensitive and drug-resistant M. tuberculosis genomes isolated from patients with and without type 2 diabetes mellitus (T2DM). We collected 399 M. tuberculosis L4 genomes from several public repositories; 224 genomes belonging to hosts without T2DM, of which 123 (54.9%) had drug sensitive tuberculosis (TB) and 101 (45.1%) had drug resistance (DR)-TB; and 175 genomes from individuals with T2DM, of which 100 (57.1%) had drug sensitive TB and 75 (42.9%) had DR-TB. The presence of SNPs in the coding regions of 65 genes related to DNA damage repair was analyzed and compared with the resistance profile and the presence/absence of T2DM in the host. The results show the phylogenetic relationships of some SNPS and L4 sub-lineages, as well as differences in the distribution of SNPs present in DNA damage repair-related genes related to the resistance profile of the infecting strain and the presence of T2DM in the host. Given these differences, it was possible to generate two discriminant functions to distinguish between drug sensitive and drug resistant genomes, as well as patients with or without T2DM.
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Affiliation(s)
- Damián E. Pérez-Martínez
- Programa de Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Av. Luis, Dr. Castelazo Ayala s/n, Col. Industrial Animas, Xalapa 91190, Mexico; (D.E.P.-M.); (G.A.B.-H.)
| | - Gustavo A. Bermúdez-Hernández
- Programa de Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud, Universidad Veracruzana, Av. Luis, Dr. Castelazo Ayala s/n, Col. Industrial Animas, Xalapa 91190, Mexico; (D.E.P.-M.); (G.A.B.-H.)
| | - Carlos F. Madrazo-Moya
- Biomedical Institute of Valencia IBV-CSIC, C. de Jaume Roig, 11, 46010 Valencia, Spain; (C.F.M.-M.); (I.C.-M.); (I.C.)
| | - Irving Cancino-Muñoz
- Biomedical Institute of Valencia IBV-CSIC, C. de Jaume Roig, 11, 46010 Valencia, Spain; (C.F.M.-M.); (I.C.-M.); (I.C.)
- CIBER of Epidemiology and Public Health, 08908 Madrid, Spain
| | - Hilda Montero
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n, A.P. 57, Col. Industrial Animas, Xalapa 91190, Mexico;
| | - Cuauhtemoc Licona-Cassani
- Escuela de Ingeniería y Ciencias, Tecnológico de Monterrey, Ave. Eugenio Garza Sada 2501 Sur, Monterrey 64849, Mexico;
- Red Multidisciplinaria de Investigación en Tuberculosis, Mexico City 14080, Mexico;
- Division of Integrative Biology, The Institute for Obesity Research, Tecnológico de Monterrey, Monterrey 64849, Mexico
| | - Raquel Muñiz-Salazar
- Red Multidisciplinaria de Investigación en Tuberculosis, Mexico City 14080, Mexico;
- Laboratorio de Epidemiología y Ecología Molecular, Escuela de Ciencias de la Salud, Universidad Autónoma de Baja California, Ensenada 22890, Mexico
| | - Iñaki Comas
- Biomedical Institute of Valencia IBV-CSIC, C. de Jaume Roig, 11, 46010 Valencia, Spain; (C.F.M.-M.); (I.C.-M.); (I.C.)
- CIBER of Epidemiology and Public Health, 08908 Madrid, Spain
| | - Roberto Zenteno-Cuevas
- Instituto de Salud Pública, Universidad Veracruzana, Av. Luis Castelazo Ayala s/n, A.P. 57, Col. Industrial Animas, Xalapa 91190, Mexico;
- Red Multidisciplinaria de Investigación en Tuberculosis, Mexico City 14080, Mexico;
- Correspondence:
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12
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Li M, Chen T, Hua Z, Yan H, Wang D, Li Z, Kang Y, Zhu N, Li C. Global, regional, and national prevalence of diabetes mellitus in patients with pulmonary tuberculosis: a systematic review and meta-analysis. Diabetol Metab Syndr 2021; 13:127. [PMID: 34717728 PMCID: PMC8557479 DOI: 10.1186/s13098-021-00743-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 10/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Both pulmonary tuberculosis (PTB) and diabetes mellitus (DM) are major global public health problems. We estimated the global, regional, and national prevalence of diabetes mellitus in a population with PTB. METHODS We searched for observational studies of DM in people with PTB using the PubMed and Embase electronic bibliographic databases, focusing on articles published in the English language from database inception until March 31, 2021. We included original research that reported the prevalence of DM in PTB or those that had sufficient data to compute these estimates. Studies were excluded if they did not provide primary data or were case studies or reviews. Two authors independently extracted the articles and collected detailed information using a predefined questionnaire. A country-specific random-effects meta-analysis was used for countries with two or more available studies, and a fractional response regression model was employed to predict the prevalence of DM in PTB for countries with one or no study. The study was registered with the International Prospective Register of Systematic Reviews, using the registration number CRD42018101989. RESULTS We identified 22,658 studies, and 153, across 51 countries, were retained for data extraction. The global prevalence of DM among patients with PTB was estimated to be 13.73% (95% confidence interval [CI] 12.51-14.95). The prevalence rates were 19.32% (95% CI 13.18-25.46) in the region of the Americas, 17.31% (95% CI 12.48-22.14) in the European region, 14.62% (95% CI 12.05-17.18) in Southeast Asia, 13.59% (95% CI 7.24-19.95) in the western Pacific region, 9.61% (95% CI 4.55-14.68) in the eastern Mediterranean region, and 9.30% (95% CI 2.83-15.76) in the African region. The country with the highest estimated prevalence was the Marshall Islands (50.12%; 95% CI 4.28-95.76). CONCLUSION Comorbid PTB and DM remain prevalent worldwide.
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Affiliation(s)
- Minmin Li
- Shaanxi Provincial Center for Disease Control and Prevention, No. 3 East Jian Road, PO Box 46, Xi'an, 710041, Shaanxi, People's Republic of China
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK
| | - Zhongqiu Hua
- Wuxi Early Intervention Center for Children with Special Needs, Wuxi, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
- Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK
| | - Zhaoqing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yijun Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Ni Zhu
- Shaanxi Provincial Center for Disease Control and Prevention, No. 3 East Jian Road, PO Box 46, Xi'an, 710041, Shaanxi, People's Republic of China.
| | - Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China.
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13
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Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Rodríguez-Reyna E, Mora-Guzmán F, Caso JA, Ledezma-Campos E, Schlesinger LS, Torrelles JB, Turner J, Restrepo BI. A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor. PLoS One 2021; 16:e0255194. [PMID: 34324578 PMCID: PMC8321126 DOI: 10.1371/journal.pone.0255194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics. METHODS Cross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression. RESULTS LTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45). CONCLUSIONS We report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.
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Affiliation(s)
- Julia M. Scordo
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
- The University of Texas Health Science Center of San Antonio, San Antonio, TX, United States of America
| | | | - Doris Ayala
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
| | - Ana Paulina Quirino-Cerrillo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
| | - Eminé Rodríguez-Reyna
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Francisco Mora-Guzmán
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Jose A. Caso
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
| | - Eder Ledezma-Campos
- Secretaria de Salud de Tamaulipas, Reynosa, Matamoros and Ciudad Victoria, Tamaulipas, México
| | - Larry S. Schlesinger
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Jordi B. Torrelles
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Joanne Turner
- Host Pathogen Interactions and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Blanca I. Restrepo
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, United States of America
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX, United States of America
- * E-mail:
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14
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Bobadilla-Del-Valle M, Leal-Vega F, Torres-Gonzalez P, Ordaz-Vazquez A, Garcia-Garcia MDL, Tovar-Vargas MDLA, Delgado-Sanchez G, Guerra De Blas PDC, Wallis RS, Ponce-De-León A, Sifuentes-Osornio J. Mycobacterial Growth Inhibition Assay (MGIA) as a Host Directed Diagnostic Tool for the Evaluation of the Immune Response in Subjects Living With Type 2 Diabetes Mellitus. Front Cell Infect Microbiol 2021; 11:640707. [PMID: 34084753 PMCID: PMC8167894 DOI: 10.3389/fcimb.2021.640707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The lack of efficient and cost-effective diagnostic tools contributes to poor control of tuberculosis in endemic countries. Moreover, host biological processes influence susceptibility, and infection resolution. It is well known that comorbidities such as type 2 diabetes mellitus (DM2) affect the host immune response, making individuals more susceptible to Mycobacterium tuberculosis infection. Currently, there are no laboratory tools that can identify those subjects who have a higher risk of developing the disease. In this study, we used a whole blood mycobacterial growth inhibition assay to assess the immune response capacity to inhibit mycobacterial growth between healthy subjects and those living with DM2 with optimal and poor glycemic control. We also measured cytokine levels in the culture supernatant by cytokine bead arrays. We included 89 patients with DM2: 54 patients with optimal control (mean age 56.2 ± 11.75 years) and 35 patients with poor control (mean age 52.05 ± 9.94 years). We also included 44 healthy subjects as controls (mean age 42.12 ± 11.75 years). We compared the Δlog UFC (a value that represents the difference between mycobacterial growth in the control tube versus the subject’s blood) between each group. Our results demonstrate that patients with DM2 had a lower capacity to inhibit M. tuberculosis growth (Δlog UFC DM2 subjects 0.9581 (-0.3897 to 2.495) vs Δlog UFC healthy subjects 0.7190 (-0.2678 to 2.098); p=0.013). Comparing subjects living with DM2 (optimal and poor glycemic control) vs healthy subjects, we found only significant differences between healthy subjects and patients poorly controlled (Δlog UFC optimal control group 0.876 (-0.3897 to 2.495); Δlog UFC poor control group 1.078 (0.068 to 2.33); Δlog UFC healthy subjects 0.7190 (-0.2678 to 2.098); p= 0.022). Therefore, glycemic control assessed by glycosylated hemoglobin values influences the capacity of the host to control the infection. Our results confirm that the whole blood mycobacterial growth inhibition assay has potential utility as an in vitro marker of M. tuberculosis immunological control in vivo in subjects living with DM2. This assay can be used to evaluate the immune response of each individual against M. tuberculosis, allowing clinicians to choose a more specific host-directed therapy.
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Affiliation(s)
- Miriam Bobadilla-Del-Valle
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Francisco Leal-Vega
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Pedro Torres-Gonzalez
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Anabel Ordaz-Vazquez
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Ma de Los Angeles Tovar-Vargas
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Guadalupe Delgado-Sanchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Paola Del Carmen Guerra De Blas
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.,LaRed- Coordinating Center, The Mexican Emerging Infectious Diseases Clinical Research Network (La Red), Mexico City, Mexico
| | | | - Alfredo Ponce-De-León
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Laboratorio de Microbiologia Clinica, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Guillén-Nepita AL, Vázquez-Marrufo G, Cruz-Hernández A, García-Oliva F, Zepeda-Gurrola RC, Vázquez-Garcidueñas MS. Detailed epidemiological analysis as a strategy for evaluating the actual behavior of tuberculosis in an apparently low-incidence region. Pathog Glob Health 2020; 114:393-404. [PMID: 32924885 DOI: 10.1080/20477724.2020.1813488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tuberculosis control in developing regions with apparent low incidence, like the low-income Mexican state of Michoacán, with mean annual incidence rates below 10/100,000 inhabitants, requires knowledge of the actual behavior of the disease. This can be determined using an epidemiological profile at sub-regional level, allowing disclosure of the clinical and social factors that may be hampering efforts to control tuberculosis. In this work, a detailed epidemiological profile was outlined using data of all new monthly cases registered in the National System of Epidemiological Surveillance Database for Michoacán municipalities from 2000 to 2012. Cases were grouped by gender and age, and sociodemographic data were obtained both from the National Institute of Statistics and Geography and from the United Nations Development Programme. Correlations were calculated by Chi-square, Mann-Whitney U, and Kruskal-Wallis H tests. We observed no statistically significant differences between notification rates for the years 2000, 2005 and 2010 (χ2 = 0.222, p = 0.895). The percentage of cases is similar between all age groups older than 15, while some regions had low notification rates but high proportions of pediatric cases. Higher proportions of cases of extrapulmonary tuberculosis were observed in municipalities in northern Michoacán. No correlation was found between municipal Human Development Index values and municipal notification rates. Michoacán is undergoing an epidemiological transition with three regions having different epidemiological profiles and particular needs for effective prevention and containment of tuberculosis. Our work shows the importance of the spatial scale of epidemiological profiles for determining specific regional needs of surveillance and containment.
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Habib SS, Rafiq S, Jamal WZ, Ayub SM, Ferrand RA, Khan A, Zaidi SMA. Engagement of private healthcare providers for case finding of tuberculosis and diabetes mellitus in Pakistan. BMC Health Serv Res 2020; 20:328. [PMID: 32306961 PMCID: PMC7168982 DOI: 10.1186/s12913-020-05217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The rising co-epidemic of tuberculosis (TB) and diabetes mellitus (DM) is a challenge for constrained health systems in low and middle-income countries. Diabetes is a known risk factor for tuberculosis and associated with poor tuberculosis treatment outcomes, while tuberculosis is associated with worsening glycemic control. We investigated the performance of bi-directional TB and DM case finding approaches through a private-sector engagement model in Karachi, Pakistan. METHODS Between July 2016 and July 2018, private health care providers were engaged to generate referrals for bi-directional TB and DM screening at private diagnostic and treatment centers in Karachi, Pakistan. Individuals diagnosed with TB underwent glycated hemoglobin (HbA1c) testing at the time of anti-tuberculous treatment initiation and at three -month follow up stage. All individuals with a history of diabetes or random blood sugar of greater than 200 mg/dl were screened for TB using a chest X-ray and Xpert MTB/RIF. RESULTS A total of 6312 persons with tuberculosis were tested on HbA1c at treatment initiation, of whom 1516 (24%) were newly diagnosed with DM. About one third of those with HbA1c in the diabetic range (≥ 6.5%) at baseline were found to have a normal HbA1c (< 5.7%) result at 3-month follow-up. A total of 3824 individuals with DM, of whom 2396 (63%) were known cases and 1428 (37%) were newly identified with random blood sugar > 200 mg/dl, underwent chest x-ray and Xpert MTB/RIF testing, with 321 (13.4%) known and 54 (3.8%) new diabetics respectively identified with tuberculosis. CONCLUSION This study demonstrates a high yield of TB and DM through bidirectional screening and the feasibility of engagement of private sector in finding missing cases of tuberculosis and diabetes. Given the high prevalence of undiagnosed DM in individuals with TB tuberculosis patients, there is a need to scale-up DM screening within TB programmes. Increased awareness of the high risk of TB among individuals with DM is needed among private health providers and screening for TB among diabetics should be strongly considered.
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Affiliation(s)
- Shifa Salman Habib
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Sana Rafiq
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Wafa Zehra Jamal
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Shaikh Muhammad Ayub
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Rashida Abbas Ferrand
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Aamir Khan
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Syed Mohammad Asad Zaidi
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
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Yorke E, Boima V, Dey ID, Ganu V, Nkornu N, Acquaye KS, Mate-Kole CC. Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia. BMC Psychiatry 2020; 20:143. [PMID: 32245444 PMCID: PMC7119271 DOI: 10.1186/s12888-020-02570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia. METHODS The current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes. Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI). RESULTS The mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants. There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037). CONCLUSION Newly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Vincent Boima
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Ida Dzifa Dey
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Norah Nkornu
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana
| | - Kelvin Samuel Acquaye
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - C. Charles Mate-Kole
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychiatry, School of Medicine & Dentistry, College of Health Sciences, Korle-Bu, Accra, Ghana
- Centre for Ageing Studies, College of Humanities, University of Ghana, Accra, Ghana
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Abstract
We investigated the distribution of comorbidities among adult tuberculosis (TB) patients in Chiapas, the poorest Mexican state, with a high presence of indigenous population, and a corridor for migrants from Latin America. Secondary analysis on 5508 new adult TB patients diagnosed between 2010 and 2014 revealed that the most prevalent comorbidities were diabetes mellitus (DM; 19.1%) and undernutrition (14.4%). The prevalence of DM in these TB patients was significantly higher among middle aged (41–64 years) compared with older adults (⩾65 years) (38.6% vs. 23.2%; P < 0.0001). The prevalence of undernutrition was lower among those with DM, and higher in communities with high indigenous presence. Immigrants only comprised 2% of all TB cases, but were more likely to have unfavourable TB treatment outcomes (treatment failure, death and default) when compared with those born in Chiapas (29.5% vs. 11.1%; P < 0.05). Unfavourable TB outcomes were also more prevalent among the TB patients with undernutrition, HIV or older age, but not DM (P < 0.05). Our study in Chiapas illustrates the challenges of other regions worldwide where social (e.g. indigenous origin, poverty, migration) and host factors (DM, undernutrition, HIV, older age) are associated with TB. Further understanding of these critical factors will guide local policy makers and health providers to improve TB management.
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Abreu RGD, Rolim LS, Sousa AIAD, Oliveira MRFD. Tuberculosis and diabetes: association with sociodemographic characteristics and diagnosis and treatment of tuberculosis. Brazil, 2007-2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200009. [PMID: 32130398 DOI: 10.1590/1980-549720200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/12/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tuberculosis and diabetes comorbidity remains a challenge for global public health. OBJECTIVE To analyze the sociodemographic profile and the diagnostic and treatment characteristics of tuberculosis cases with and without diabetes in Brazil. METHODS This is a cross-sectional study with data from the Notifiable Diseases Information System and the Hypertension and Diabetes Mellitus Primary Care Clinical Management System, from 2007 to 2011. We adopted a Poisson regression model with robust variance to estimate the prevalence ratios (PR) and their respective confidence intervals. RESULTS We found the studied comorbidity in 7.2% of cases. The hierarchical model showed a higher PR among women (PR=1.31; 95% confidence interval - 95%CI 1.27-1.35); a greater association in the age groups 40-59 years and ≥ 60 years (PR=11.70; 95%CI 10.21-13.39, and PR=17.49; 95%CI 15.26-20.05), and in those with positive sputum smear microscopy results - 1st sample (PR=1.40; 95%CI 1.35-1.47). Return after treatment discontinuation and treatment discontinuation were inversely associated with comorbidity (PR=0.66; 95%CI 0.57-0.76 and PR=0.79; 95%CI 0.72-0.87). CONCLUSION The findings, such as the inverse relationship with tuberculosis treatment discontinuation in the group of people with comorbidity, reinforce the importance of integrated actions in health services to change the scenario of this challenging comorbidity.
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Affiliation(s)
| | - Lúcia Santana Rolim
- Ministério da Saúde, Secretaria de Vigilância Sanitária - Brasília (DF), Brasil
| | | | - Maria Regina Fernandes de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical - Brasília (DF), Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Conselho Nacional de Desenvolvimento Científico e Tecnológico - Porto Alegre (UF), Brasil
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Cheng J, Sun YN, Zhang CY, Yu YL, Tang LH, Peng H, Peng Y, Yao YX, Hou SY, Li JW, Zhao JM, Xia L, Xu L, Xia YY, Zhao F, Wang LX, Zhang H. Incidence and risk factors of tuberculosis among the elderly population in China: a prospective cohort study. Infect Dis Poverty 2020; 9:13. [PMID: 32005290 PMCID: PMC6995187 DOI: 10.1186/s40249-019-0614-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background China is facing challenges of the shifting presentation of tuberculosis (TB) from younger to elderly due to an ageing population, longer life expectancy and reactivation disease. However, the burden of elderly TB and influence factors are not yet clear. To fill the gap, we generated a cohort study to measure the magnitude of TB incidence and associated factors among the elderly population aged 65 years and above in China. Methods In this cohort established in 2013 through a prevalence survey conducted in selected sites, a total of 34 076 elderlies without TB were enrolled into two-year follow-up. We used both active and passive case findings to find out all TB patients among them. The person-year (PY) incidence rates for both bacteriologically positive TB and active TB were calculated. Cox proportional regression model was performed to test effect of risk factors, and the population attributable fraction (PAF) of each risk factor contributing to incident TB among elderlies was calculated. Results Over the two-year follow-up period, a total of 215 incident active TB were identified, 62 of which were bacteriologically positive. The incidence rates for active TB and bacteriologically positive TB were 481.8 per 100 000 PY (95% CI: 417.4–546.2 per 100 000 PY) and 138.9 per 100 000 PY (95% CI: 104.4–173.5 per 100 000 PY), respectively. Incident cases detected by active case finding were significantly higher (P < 0.001). Male, non-Han nationality, previously treated TB, ex/current smoker and body mass index (BMI) < 18.5 presented as independent predictors for developing TB disease. For developing bacteriologically positive TB, the biggest contribution was from self-reported ex or current smoker (18.06%). And, for developing active TB, the biggest contribution was from non-Han nationality (35.40%), followed by male (26.80%) and age at 75 years and above (10.85%). Conclusions Ageing population in China had a high TB incidence rate and risk to develop TB disease, implying that National TB Program (NTP) needs to prioritize for elderly. Active case finding should be applied capture more active TB cases among this particular population, especially for male, non-Han nationality, and those with identified risk factors.
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Affiliation(s)
- Jun Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan-Ni Sun
- National Center for Population Health and Epidemiology, Canberra, Australia
| | - Can-You Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan-Ling Yu
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Li-Hong Tang
- Minhang District Center for Disease Control and Prevention, Shanghai, China
| | - Hong Peng
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ying Peng
- Zhejiang Provincial Center for Disease Control and prevention, Hangzhou, China
| | - Yu-Xia Yao
- Henan Provincial Center for Disease control and prevention, Zhengzhou, China
| | - Shuang-Yi Hou
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Jian-Wei Li
- Center for Tuberculosis Control of Guangdong Province, Guangzhou, China
| | - Jin-Ming Zhao
- GuangXi Center for Disease Prevention and Control, Nanning, China
| | - Lan Xia
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Lin Xu
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Yin-Yin Xia
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fei Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li-Xia Wang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Hui Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Song C, Xie W, Gong L, Ren M, Pan P, Luo B. The relationship between HbA1c control levels and antituberculosis treatment effects: a meta-analysis. J Chin Med Assoc 2019; 82:915-921. [PMID: 31800532 DOI: 10.1097/jcma.0000000000000205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Multiple studies of tuberculosis (TB) treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-TB treatment effects in patients afflicted with both TB and DM. METHODS Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-TB treatment effects (sputum conversion rate [SCR] and TB focus absorption) in diabetic patients receiving treatment for TB. We used RevMan 5.3 software to analyze the data. RESULTS We included 12 studies, of which five reported SCR at 2 months, seven reported the conversion at 3 months, and seven reported TB focus absorption. According to the five studies which reported 2 months-SCR, patients with diabetes and TB had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the 2 months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, additional seven studies reporting 3 months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the 12 studies demonstrated that there were differences in TB focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79). CONCLUSION HbA1c control levels influence the SCR at 3 months and the TB focus absorption at the end of the anti-TB intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.
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Affiliation(s)
- Chao Song
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Wang Xie
- Tongji University, Shanghai, China
| | - Li Gong
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Min Ren
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Pinhua Pan
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
| | - Bailing Luo
- Respiratory Department, Xiangya Hospital, Central South University, Changsha, China
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Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7640836. [PMID: 31781641 PMCID: PMC6875401 DOI: 10.1155/2019/7640836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/17/2019] [Indexed: 01/21/2023]
Abstract
Background Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. Methodology We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. Result The prevalence of diabetes mellitus in this study was 13.5%. Age 26–40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. Conclusion This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.
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Kou T, Wang Q, Lv W, Wei B, Liu Y, Zhao S, Du X, Zou Y, Sun L, Tian H, Zhao Z, Liu Q, Dong C, Zhang G, Gao X, Yu C. Poor Sleep Quality Is Associated with a Higher Risk of Pulmonary tuberculosis in Patients with a Type 2 Diabetes Mellitus Course for More than 5 Years. Jpn J Infect Dis 2019; 72:243-249. [PMID: 30918145 DOI: 10.7883/yoken.jjid.2018.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case-control study was conducted in Shandong from January to December 2017 to explore the relationship between sleep quality and the risk of active pulmonary tuberculosis (PTB). Seventy-nine patients with type 2 diabetes mellitus coincident with newly diagnosed pulmonary tuberculosis (DM-PTB) and 169 age, sex, and DM course frequency-matched controls (DM alone) were enrolled. Univariate and multivariable unconditional logistic regression analyses were conducted. We further conducted subgroup analyses to explore the relationship between sleep quality and PTB risk, including DM course (≤5 and >5 years), age, sex, and the presence of overweight or obesity (body mass index (BMI) > 24 kg/m2). Multivariate logistic regression demonstrated that poor sleep quality had a borderline negative association with the odds of PTB (P = 0.065). Subgroup multivariate analyses showed that poor sleep quality increased the risk of PTB to more than 3 times among patients with a DM course > 5 years (odds ratio 3.31, 95% confidence interval: 1.08-10.13; P = 0.036) after adjusting for potential confounding factors including residential area, educational level, BMI, history of contact with tuberculosis patients, smoking, alcohol consumption, physical exercise, immune status, and frequency of blood glucose monitoring. In conclusion, poor sleep quality is an independent risk factor of PTB among DM patients with a course of > 5 years, which indicates significant epidemiological implications for PTB control.
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Affiliation(s)
- Tingyan Kou
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Qiuzhen Wang
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Wenshan Lv
- Endocrinology and metabolic Department, The affiliated hospital of Qingdao University
| | - Boyang Wei
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Yufeng Liu
- Clinical Department, Qingdao Chest Hospital
| | | | - Xiuping Du
- Endocrine Department, Gaomi people's Hospital
| | - Yue Zou
- Clinical Department, Qingdao Chest Hospital
| | - Limei Sun
- Clinical Department, Qingdao Chest Hospital
| | - Hong Tian
- Clinical Department, Qingdao Chest Hospital
| | - Zhenlei Zhao
- Clinical Department, Linyi Third people's Hospital
| | - Qian Liu
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Chunjiang Dong
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Guilan Zhang
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Xiaoli Gao
- Institute of Human Nutrition, The Medical College of Qingdao University
| | - Caiting Yu
- Institute of Human Nutrition, The Medical College of Qingdao University
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Awad SF, Dargham SR, Omori R, Pearson F, Critchley JA, Abu-Raddad LJ. Analytical Exploration of Potential Pathways by which Diabetes Mellitus Impacts Tuberculosis Epidemiology. Sci Rep 2019; 9:8494. [PMID: 31186499 PMCID: PMC6560095 DOI: 10.1038/s41598-019-44916-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
We aimed to develop a conceptual framework of diabetes mellitus (DM) effects on tuberculosis (TB) natural history and treatment outcomes, and to assess the impact of these effects on TB-transmission dynamics. The model was calibrated using TB data for India. A conceptual framework was developed based on a literature review, and then translated into a mathematical model to assess the impact of the DM-on-TB effects. The impact was analyzed using TB-disease incidence hazard ratio (HR) and population attributable fraction (PAF) measures. Evidence was identified for 10 plausible DM-on-TB effects. Assuming a flat change of 300% (meaning an effect size of 3.0) for each DM-on-TB effect, the HR ranged between 1.0 (Effect 9-Recovery) and 2.7 (Effect 2-Fast progression); most effects did not have an impact on the HR. Meanwhile, TB-disease incidence attributed directly and indirectly to each effect ranged between -4.6% (Effect 7-TB mortality) and 34.5% (Effect 2-Fast progression). The second largest impact was for Effect 6-Disease infectiousness at 29.9%. In conclusion, DM can affect TB-transmission dynamics in multiple ways, most of which are poorly characterized and difficult to assess in epidemiologic studies. The indirect (e.g. onward transmission) impacts of some DM-on-TB effects are comparable in scale to the direct impacts. While the impact of several effects on the HR was limited, the impact on the PAF was substantial suggesting that DM could be impacting TB epidemiology to a larger extent than previously thought.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
| | - Ryosuke Omori
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Hokkaido, Japan
- Japan Science and Technology Agency, PRESTO, Kawaguchi, Saitama, Japan
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Fiona Pearson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.
- College of Health and Life Sciences, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar.
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Bello-López JM, León-García G, Rojas-Bernabé A, Fernández-Sánchez V, García-Hernández O, Mancilla Rámirez J, Ibáñez-Cervantes G. Morbidity Trends and Risk of Tuberculosis: Mexico 2007-2017. Can Respir J 2019; 2019:8295261. [PMID: 31178943 PMCID: PMC6501252 DOI: 10.1155/2019/8295261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/14/2018] [Accepted: 03/20/2019] [Indexed: 12/12/2022] Open
Abstract
Background To know the current status of the epidemiological and geographic distribution of tuberculosis and its complication meningeal tuberculosis in Mexico, this work analyzes national surveillance data (ten years) issued by the General Directorate of Epidemiology (GDE). Methods An observational and retrospective analysis of monthly and annual reports of pulmonary and meningeal tuberculosis cases from January 2007 to December 2017 was performed on the annual reports issued by the GDE in Mexico. The number of cases and incidence were classified by year, state, age group, gender, and seasons. Results A national case distribution map of pulmonary and meningeal tuberculosis incidence was generated. During this period, a total of 184,003 and 3,388 cases were reported with a median of 16,727.5 and 308 cases per year for pulmonary and meningeal tuberculosis diseases, respectively. The number of cases and incidence of pulmonary and meningeal tuberculosis per year showed that male gender presented a continuous increase in both parameters. The geographic analysis of the distribution of cases of tuberculosis showed that states like Guerrero, Tabasco, and Veracruz presented higher means of tuberculosis cases during this period. Northern states had the highest number of cases in the country compared to other states. In Mexico, pulmonary tuberculosis and meningeal tuberculosis are seasonal. Interestingly, cases of meningeal tuberculosis show an increase during October and November (autumn). Conclusions In Mexico, during the years 2007-2017, there has been an increase in the proportion of male TB patients. It remains necessary to implement strategies to detect TB in the adult population, especially among men, because tuberculosis could be difficult to recognize in an early stage in the population, and the appearance of resistant strains can cause an increase in the incidence of the disease.
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Affiliation(s)
- Juan Manuel Bello-López
- Unidad de Investigación en Microbiología y Toxicología, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Col. Magdalena de las Salinas, 07360 Mexico City, Mexico
| | - Gregorio León-García
- Hospital de la Mujer, SSA, Salvador Díaz Mirón 374, Col. Santo Tomas, 11340 Mexico City, Mexico
- Centro Médico y de Investigaciones Científicas Fundación CIAM ESPERAS, A.C., Felipe Carrillo Puerto 181, Col. Popotla, 11400 Mexico City, Mexico
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Salvador Díaz Mirón, Col. Casco de Santo Tomas, 11340 Mexico City, Mexico
| | - Araceli Rojas-Bernabé
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Salvador Díaz Mirón, Col. Casco de Santo Tomas, 11340 Mexico City, Mexico
| | | | - Omar García-Hernández
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Javier Mancilla Rámirez
- Hospital de la Mujer, SSA, Salvador Díaz Mirón 374, Col. Santo Tomas, 11340 Mexico City, Mexico
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Salvador Díaz Mirón, Col. Casco de Santo Tomas, 11340 Mexico City, Mexico
| | - Gabriela Ibáñez-Cervantes
- Hospital de la Mujer, SSA, Salvador Díaz Mirón 374, Col. Santo Tomas, 11340 Mexico City, Mexico
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Salvador Díaz Mirón, Col. Casco de Santo Tomas, 11340 Mexico City, Mexico
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Alebel A, Wondemagegn AT, Tesema C, Kibret GD, Wagnew F, Petrucka P, Arora A, Ayele AD, Alemayehu M, Eshetie S. Prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2019; 19:254. [PMID: 30866836 PMCID: PMC6417234 DOI: 10.1186/s12879-019-3892-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 03/07/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tuberculosis and diabetes mellitus are significant global public health challenges. In Sub-Saharan Africa, study findings regarding prevalence of diabetes mellitus amongst tuberculosis patients have been inconsistent and highly variable. Therefore, this systematic review and meta-analysis estimates the overall prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa. METHODS Four international databases (PubMed, Google Scholar, Science Direct and Cochrane Library) were systematically searched. We included all observational studies reporting the prevalence of DM among TB patients in Sub-Saharan Africa. All necessary data for this review were extracted using a standardized data extraction format by two authors (CT and AA1). STATA Version 14 statistical software was employed to conduct meta-analysis. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of diabetes mellitus in TB patients. Besides, subgroup analysis was done based on different factors. RESULTS In the meta-analysis, sixteen studies fulfilled the inclusion criteria and were included. The findings of these 16 studies revealed that the pooled prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was 9.0% (95% CI: 6.0, 12.0%). The highest prevalence of diabetes mellitus among tuberculosis patients was found in Nigeria (15%), followed by Tanzania (11%), and then Ethiopia (10%). Besides, the prevalence of diabetes mellitus among HIV infected TB patients was (8.9%) which is slightly higher than HIV uninfected (7.7%) TB patients. CONCLUSION Diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was significantly high. Moreover, this study found that there was a high prevalence of DM among HIV infected than uninfected TB patients. It is strongly recommended to screen for DM among TB patients and special emphasis should be given for early screening of DM among TB/HIV co-infected patients.
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Affiliation(s)
- Animut Alebel
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | - Cheru Tesema
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Fasil Wagnew
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145 Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
| | - Amare Demsie Ayele
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Alemayehu
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Setegn Eshetie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fernández-Ruiz JC, Galindo-De Ávila JC, Martínez-Fierro ML, Garza-Veloz I, Cervantes-Villagrana AR, Valtierra-Alvarado MA, Serrano CJ, García-Hernández MH, Enciso-Moreno JA, Castañeda-Delgado JE. Myeloid-Derived Suppressor Cells Show Different Frequencies in Diabetics and Subjects with Arterial Hypertension. J Diabetes Res 2019; 2019:1568457. [PMID: 31915708 PMCID: PMC6930726 DOI: 10.1155/2019/1568457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/10/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes mellitus (DM2) is strongly associated with other comorbidities such as obesity, atherosclerosis, and hypertension. Obesity is associated with sustained low-grade inflammatory response due to the production of proinflammatory cytokines. This inflammatory process promotes the differentiation of some myeloid cells, including myeloid-derived suppressor cells (MDSCs). In this study, two groups of individuals were included: DM2 patients and non-DM2 individuals with similar characteristics. Immunolabeling of CD15+ CD14- and CD33+ HLA-DR-/low was performed from whole peripheral blood, and samples were analyzed by flow cytometry, and frequencies of MDSCs and the relationship of these with clinical variables, cytokine profile (measured by cytometric bead array), and anthropometric variables were analyzed. The frequency of CD33+ HLA-DR-/low MDSCs (that produce IL-10 and TGF-β, according to an intracellular detection) is higher in patients with DM2 (P < 0.05), and there is a positive correlation between the frequency of CD15+ CD14- and CD33+ HLA-DR-/low MDSC phenotypes. DM2 patients have an increased concentration of serum IL-5 (P < 0.05). Also, a negative correlation between the frequency of CD15+ CD14- MDSCs and LDL cholesterol was found. Our group of DM2 patients have an increased frequency of mononuclear MDSC CD33+ HLA-DR-/low that produce TGF-β and IL-10. These cytokines have been associated with immune modulation and reduced T cell responses. DM2 and non-DM2 subjects show a similar cytokine profile, but the DM2 patients have an increased concentration of IL-5.
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Affiliation(s)
- Julio C. Fernández-Ruiz
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
- Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Julia C. Galindo-De Ávila
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
- Maestría en Ciencias Biomédicas, Área de Ciencias de la Salud, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Margarita L. Martínez-Fierro
- Laboratorio de Medicina Molecular, Unidad Académica de Medicina Humana y Ciencias de la Salud, Campus UAZ XXI, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | - Idalia Garza-Veloz
- Laboratorio de Medicina Molecular, Unidad Académica de Medicina Humana y Ciencias de la Salud, Campus UAZ XXI, Universidad Autónoma de Zacatecas, Zacatecas, Mexico
| | | | - Monica A. Valtierra-Alvarado
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
- Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Carmen J. Serrano
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
| | | | - José A. Enciso-Moreno
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
| | - Julio E. Castañeda-Delgado
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social, Zacatecas, Mexico
- Cátedras CONACYT, Consejo Nacional de Ciencia y Tecnología, Mexico
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McMurry HS, Mendenhall E, Rajendrakumar A, Nambiar L, Satyanarayana S, Shivashankar R. Coprevalence of type 2 diabetes mellitus and tuberculosis in low-income and middle-income countries: A systematic review. Diabetes Metab Res Rev 2019; 35:e3066. [PMID: 30144270 DOI: 10.1002/dmrr.3066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/12/2018] [Accepted: 08/18/2018] [Indexed: 11/09/2022]
Abstract
Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.
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Affiliation(s)
- Hannah Stowe McMurry
- University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Chronic Disease Control, Delhi, India
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - Lavanya Nambiar
- Public Health Foundation of India, Delhi, India
- Department of Health Policy, Management Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, Delhi, India
- Public Health Foundation of India, Delhi, India
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Dousa KM, Hamad A, Albirair M, Al Soub H, Elzouki AN, Alwakeel MI, Thiel BA, Johnson JL. Impact of Diabetes Mellitus on the Presentation and Response to Treatment of Adults With Pulmonary Tuberculosis in Qatar. Open Forum Infect Dis 2018; 6:ofy335. [PMID: 30631793 PMCID: PMC6324545 DOI: 10.1093/ofid/ofy335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/12/2018] [Accepted: 12/14/2018] [Indexed: 01/26/2023] Open
Abstract
Background Persons with diabetes mellitus (DM) have a 3-fold increased risk of tuberculosis (TB). Atypical radiographic findings and differences in bacteriologic response during anti-TB treatment have been reported in earlier studies; however, the findings have varied. We evaluated the effect of DM on manifestations and response to treatment in adults with pulmonary TB in Qatar. Methods The impact of DM on the clinical and radiographic presentations of pulmonary TB and bacteriologic response during anti-TB treatment was evaluated between January 2007 and December 2011, comparing patients with and without DM. This is a retrospective unmatched case-control study conducted at a large national hospital. Cases and controls were randomly selected from patients diagnosed with pulmonary TB over a 5-year period. Sputum culture conversion was assessed after 2 months of anti-TB treatment. Results Clinical symptoms were similar between patients with and without DM. Patients with DM had a higher initial sputum acid-fast bacillus (AFB) smear grade and were less likely to have cavitary lesions on initial chest radiographs than patients without DM. Of 134 adults with DM and TB, 71 (53%) remained sputum culture positive after 2 months of anti-TB treatment, compared with 36 (27%) patients without DM. Conclusions DM was associated with atypical radiographic findings and delayed sputum culture conversion at 2 months in adults with pulmonary TB in Qatar. Increased health education of patients with DM about symptoms of TB, low thresholds for evaluation for active TB, and close monitoring of bacteriologic response to treatment among patients with TB and DM are warranted.
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Affiliation(s)
- Khalid M Dousa
- Division of Infectious Diseases & HIV Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Abdelrahman Hamad
- Department of Internal Medicine, Weill Cornell Medical Collage, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Albirair
- Department of Global Health, University of Washington, Seattle, Washington
| | - Hussam Al Soub
- Department of Internal Medicine, Weill Cornell Medical Collage, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Internal Medicine, Weill Cornell Medical Collage, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud I Alwakeel
- Department of Internal Medicine, Weill Cornell Medical Collage, Hamad Medical Corporation, Doha, Qatar
| | - Bonnie A Thiel
- Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John L Johnson
- Division of Infectious Diseases & HIV Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Mukhtar F, Butt ZA. Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study. PLoS One 2018; 13:e0207148. [PMID: 30408109 PMCID: PMC6224090 DOI: 10.1371/journal.pone.0207148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups. MATERIALS AND METHODS This prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome. RESULTS Of 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94). CONCLUSION Our study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.
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Affiliation(s)
- Fatima Mukhtar
- Department of Community Medicine, Lahore Medical & Dental College, Lahore, Pakistan
- Department of Epidemiology & Biostatistics, Health Services Academy, Islamabad, Pakistan
- * E-mail:
| | - Zahid A. Butt
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Department of Epidemiology & Biostatistics, Health Services Academy, Islamabad, Pakistan
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Yorke E, Boima V, Dey ID, Atiase Y, Akpalu J, Yawson AE, Ganu V, Forson A, Mate-Kole CC. Examination of Dysglycaemia among Newly Diagnosed Tuberculosis Patients in Ghana: A Cross-Sectional Study. Tuberc Res Treat 2018; 2018:1830372. [PMID: 30345114 PMCID: PMC6174760 DOI: 10.1155/2018/1830372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023] Open
Abstract
The burden of both tuberculosis (TB) and diabetes mellitus in developing countries including Ghana is high; often, the two coexist and impact each other negatively. Objective. The study aimed to determine the prevalence and predictive factors of dysglycaemia among newly diagnosed smear positive tuberculosis patients at a tertiary tuberculosis treatment centre in Ghana. Methods. Dysglycaemia at diagnosis was determined by the use of oral glucose tolerance test (OGTT), while sputum smear microscopy was used to assess the sputum status. Only smear positive patients were included in the study. Information on sociodemographic, anthropometrical, clinical, and medication history was also obtained. Results. In all, 146 participants, aged 18 to 75 years with a mean age of 38.7 years comprising 115 (78.8%) males and 31 (21.2%) females, were involved in the analysis. Upon initial screening, using fasting plasma glucose (FPG), 91.1 % had normal fasting level, 5.5 % had impaired fasting, and 3.4% were diagnosed with diabetes. Using 2-hour postprandial values (2HPP), 59.6% had normal plasma glucose, 28.8 % had impaired glucose tolerance (IGT), and 11.6 % were diagnosed with diabetes. Overall, the prevalence of dysglycaemia (i.e., impaired fasting and diabetes) was 8.9% (95% CI: 5.21-14.82%) with FPG test and 40.4% (95% CI: 32.68-48.65%) with 2HPP test. The analysis revealed that 2HPP was associated with high mean age compared to FPG (36.67 ± 13.97 versus 41.69 ± 13.97, p-value = 0.033). In addition, marital status was significantly associated with FPG status of patients (p = 0.028). Conclusion. The prevalence of dysglycaemia was high among smear positive TB patients in Ghana. Higher mean age and marital status were associated with abnormal glucose tolerance and fasting plasma glucose, respectively. Clinical management of patients with tuberculosis should include screening for diabetes.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Vincent Boima
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Ida Dzifa Dey
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Yacoba Atiase
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Josephine Akpalu
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, University of Ghana, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Audrey Forson
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - C. Charles Mate-Kole
- Department of Psychiatry, School of Medicine & Dentistry, College of Health Sciences, Korle-Bu, Ghana
- Centre for Ageing Studies, College of Humanities, University of Ghana, Ghana
- Department of Psychology, College of Humanities, University of Ghana, Ghana
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Olive AJ, Sassetti CM. Tolerating the Unwelcome Guest; How the Host Withstands Persistent Mycobacterium tuberculosis. Front Immunol 2018; 9:2094. [PMID: 30258448 PMCID: PMC6143787 DOI: 10.3389/fimmu.2018.02094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Our understanding of the host response to infections has historically focused on “resistance” mechanisms that directly control pathogen replication. However, both pathogen effectors and antimicrobial immune pathways have the capacity to damage host tissue, and the ability to tolerate these insults can also be critical for host survival. These “tolerance” mechanisms may be equally as important as resistance to prevent disease in the context of a persistent infection, such as tuberculosis, when resistance mechanisms are ineffective and the pathogen persists in the tissue for long periods. Host tolerance encompasses a wide range of strategies, many of which involve regulation of the inflammatory response. Here we will examine general strategies used by macrophages and T cells to promote tolerance in the context of tuberculosis, and focus on pathways, such as regulation of inflammasome activation, that are emerging as common mediators of tolerance.
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Affiliation(s)
- Andrew J Olive
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, United States
| | - Christopher M Sassetti
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, United States
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Govender K, Adamson JH, Owira P. The development and validation of a LC-MS/MS method for the quantitation of metformin, rifampicin and isoniazid in rat plasma using HILIC chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1095:127-137. [DOI: 10.1016/j.jchromb.2018.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 12/27/2022]
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Zhao Y, Yang X, Zhang X, Yu Q, Zhao P, Wang J, Duan C, Li J, Johnson H, Feng X, Zhang H. IP-10 and RANTES as biomarkers for pulmonary tuberculosis diagnosis and monitoring. Tuberculosis (Edinb) 2018; 111:45-53. [PMID: 30029914 DOI: 10.1016/j.tube.2018.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/20/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to determine whether IP-10 and RANTES plasma levels can be used in diagnosis and monitoring of pulmonary tuberculosis (PTB). METHODS Plasma levels of cytokines/chemokines were measured using a Bio-Plex® multiplex cytokine assay system in a cohort containing 457 clinically suspected PTB patients including a training set (n = 41)and two independent test sets A (n = 242) and B (n = 174). RESULTS Plasma levels of IP-10 and RANTES were significantly higher in PTB patients than healthy controls' in both training and independent test sets (P < 0.05). Compared with other combinations, the combination of IP-10 and RANTES had the best performance with an AUC of 1.0 in training set. The performance characteristic of this model was successfully validated in independent test set A although this combination only resulted in a slightly improvement of AUC value in independent test set B. Plasma IP-10 and RANTES levels were weakly and positively correlated with blood glucose concentrations. Moreover, IP-10 levels were positively correlated with CRP and ESR in PTB patients. Furthermore, in response to therapy, both IP-10 and RANTES levels significantly decreased over the period of 6 months (P < 0.001). CONCLUSIONS Taken together, combination of IP-10 and RANTES could be potentially used as diagnostic and monitoring biomarker in PTB management.
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Affiliation(s)
- Yanfeng Zhao
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China; Beijing Research Institute for Tuberculosis Control, No 5, Dongguang Hutong, Xinjiekou, Beijing, 100035, China
| | - Xiqin Yang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Xuhui Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Qin Yu
- Chaoyang District Center for Disease Control and Prevention, 25 Panjiayuan, Huaweili, Beijing, 100029, China
| | - Ping Zhao
- Chaoyang District Center for Disease Control and Prevention, 25 Panjiayuan, Huaweili, Beijing, 100029, China
| | - Jianxia Wang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Cuimi Duan
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | - Jiangxue Li
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China
| | | | - Xiaoyan Feng
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China.
| | - Heqiu Zhang
- Department of Bio-diagnosis, Institute of Basic Medical Sciences, 27, Taiping Road, Beijing, 100850, China.
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Mendoza-Almanza G, Rivas-Santiago CE, Salgado Bustamante M, López-Hernández Y. Diabetes and tuberculosis in Mexico: results from epidemiological studies. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-017-0599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Blanco-Guillot F, Castañeda-Cediel ML, Cruz-Hervert P, Ferreyra-Reyes L, Delgado-Sánchez G, Ferreira-Guerrero E, Montero-Campos R, Bobadilla-del-Valle M, Martínez-Gamboa RA, Torres-González P, Téllez-Vazquez N, Canizales-Quintero S, Yanes-Lane M, Mongua-Rodríguez N, Ponce-de-León A, Sifuentes-Osornio J, García-García L. Genotyping and spatial analysis of pulmonary tuberculosis and diabetes cases in the state of Veracruz, Mexico. PLoS One 2018. [PMID: 29534104 PMCID: PMC5849303 DOI: 10.1371/journal.pone.0193911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Genotyping and georeferencing in tuberculosis (TB) have been used to characterize the distribution of the disease and occurrence of transmission within specific groups and communities. Objective The objective of this study was to test the hypothesis that diabetes mellitus (DM) and pulmonary TB may occur in spatial and molecular aggregations. Material and methods Retrospective cohort study of patients with pulmonary TB. The study area included 12 municipalities in the Sanitary Jurisdiction of Orizaba, Veracruz, México. Patients with acid-fast bacilli in sputum smears and/or Mycobacterium tuberculosis in sputum cultures were recruited from 1995 to 2010. Clinical (standardized questionnaire, physical examination, chest X-ray, blood glucose test and HIV test), microbiological, epidemiological, and molecular evaluations were carried out. Patients were considered “genotype-clustered” if two or more isolates from different patients were identified within 12 months of each other and had six or more IS6110 bands in an identical pattern, or < 6 bands with identical IS6110 RFLP patterns and spoligotype with the same spacer oligonucleotides. Residential and health care centers addresses were georeferenced. We used a Jeep hand GPS. The coordinates were transferred from the GPS files to ArcGIS using ArcMap 9.3. We evaluated global spatial aggregation of patients in IS6110-RFLP/ spoligotype clusters using global Moran´s I. Since global distribution was not random, we evaluated “hotspots” using Getis-Ord Gi* statistic. Using bivariate and multivariate analysis we analyzed sociodemographic, behavioral, clinic and bacteriological conditions associated with “hotspots”. We used STATA® v13.1 for all statistical analysis. Results From 1995 to 2010, 1,370 patients >20 years were diagnosed with pulmonary TB; 33% had DM. The proportion of isolates that were genotyped was 80.7% (n = 1105), of which 31% (n = 342) were grouped in 91 genotype clusters with 2 to 23 patients each; 65.9% of total clusters were small (2 members) involving 35.08% of patients. Twenty three (22.7) percent of cases were classified as recent transmission. Moran`s I indicated that distribution of patients in IS6110-RFLP/spoligotype clusters was not random (Moran`s I = 0.035468, Z value = 7.0, p = 0.00). Local spatial analysis showed statistically significant spatial aggregation of patients in IS6110-RFLP/spoligotype clusters identifying “hotspots” and “coldspots”. GI* statistic showed that the hotspot for spatial clustering was located in Camerino Z. Mendoza municipality; 14.6% (50/342) of patients in genotype clusters were located in a hotspot; of these, 60% (30/50) lived with DM. Using logistic regression the statistically significant variables associated with hotspots were: DM [adjusted Odds Ratio (aOR) 7.04, 95% Confidence interval (CI) 3.03–16.38] and attending the health center in Camerino Z. Mendoza (aOR18.04, 95% CI 7.35–44.28). Conclusions The combination of molecular and epidemiological information with geospatial data allowed us to identify the concurrence of molecular clustering and spatial aggregation of patients with DM and TB. This information may be highly useful for TB control programs.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | | | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Norma Téllez-Vazquez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Sergio Canizales-Quintero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Norma Mongua-Rodríguez
- Doctorado en Geografía, Universidad Nacional Autónoma de México, Ciudad de México, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Ciudad de México, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, México
- * E-mail:
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Waterhouse M, Wilson C, White VLC, Chowdhury TA. Resolution of Insulin-Requiring Diabetes after Cessation of Chemotherapy for Tuberculosis. J R Soc Med 2017; 98:270-1. [PMID: 15928378 PMCID: PMC1142232 DOI: 10.1177/014107680509800607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mona Waterhouse
- Department of Diabetes and Metabolism, The Royal London Hospital, London, UK
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Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0187967. [PMID: 29161276 PMCID: PMC5697825 DOI: 10.1371/journal.pone.0187967] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022] Open
Abstract
The burgeoning epidemic of diabetes mellitus (DM) is one of the major global health challenges. We systematically reviewed the published literature to provide a summary estimate of the association between DM and active tuberculosis (TB). We searched Medline and EMBASE databases for studies reporting adjusted estimates on the TB–DM association published before December 22, 2015, with no restrictions on region and language. In the meta-analysis, adjusted estimates were pooled using a DerSimonian-Laird random-effects model, according to study design. Risk of bias assessment and sensitivity analyses were conducted. 44 eligible studies were included, which consisted of 58,468,404 subjects from 16 countries. Compared with non-DM patients, DM patients had 3.59–fold (95% confidence interval (CI) 2.25–5.73), 1.55–fold (95% CI 1.39–1.72), and 2.09–fold (95% CI 1.71–2.55) increased risk of active TB in four prospective, 16 retrospective, and 17 case-control studies, respectively. Country income level (3.16–fold in low/middle–vs. 1.73–fold in high–income countries), background TB incidence (2.05–fold in countries with >50 vs. 1.89–fold in countries with ≤50 TB cases per 100,000 person-year), and geographical region (2.44–fold in Asia vs. 1.71–fold in Europe and 1.73–fold in USA/Canada) affected appreciably the estimated association, but potential risk of bias, type of population (general versus clinical), and potential for duplicate data, did not. Microbiological ascertainment for TB (3.03–fold) and/or blood testing for DM (3.10–fold), as well as uncontrolled DM (3.30–fold), resulted in stronger estimated association. DM is associated with a two- to four-fold increased risk of active TB. The association was stronger when ascertainment was based on biological testing rather than medical records or self-report. The burgeoning DM epidemic could impact upon the achievements of the WHO “End TB Strategy” for reducing TB incidence.
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Affiliation(s)
- Rami H. Al-Rifai
- Infectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- * E-mail: ,
| | - Fiona Pearson
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- College of Public Health, Hamad bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
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Farrag MA, Dwedar IA, Samy NM. Study of pulmonary tuberculosis in type 2 diabetes in reference to clinical, radiological presentation and response to treatment. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Blanco-Guillot F, Delgado-Sánchez G, Mongua-Rodríguez N, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Yanes-Lane M, Montero-Campos R, Bobadilla-del-Valle M, Torres-González P, Ponce-de-León A, Sifuentes-Osornio J, Garcia-Garcia L. Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0184675. [PMID: 28902922 PMCID: PMC5597214 DOI: 10.1371/journal.pone.0184675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus. Materials and methods We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words “tuberculosis AND transmission” OR “tuberculosis diabetes mellitus” OR “Mycobacterium tuberculosis molecular epidemiology” OR “RFLP-IS6110” OR “Spoligotyping” OR “MIRU-VNTR”. Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used. Results Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40–1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429). Conclusion There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.
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Affiliation(s)
- Francles Blanco-Guillot
- Doctorado en Ciencias en Enfermedades Infecciosas, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Maestría en Ciencias Médicas con énfasis en Epidemiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Mercedes Yanes-Lane
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Pedro Torres-González
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Lourdes Garcia-Garcia
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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Herrera MT, Gonzalez Y, Hernández-Sánchez F, Fabián-San Miguel G, Torres M. Low serum vitamin D levels in type 2 diabetes patients are associated with decreased mycobacterial activity. BMC Infect Dis 2017; 17:610. [PMID: 28882103 PMCID: PMC5590153 DOI: 10.1186/s12879-017-2705-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/23/2017] [Indexed: 01/30/2023] Open
Abstract
Background Concurrent diabetes mellitus and tuberculosis represent a significant health problem worldwide. Patients with diabetes mellitus have a high risk of tuberculosis, which may be mediated by an abnormal innate immune response due to hyperglycaemia or low vitamin D levels. Methods In the present study, we evaluated inactive vitamin D serum levels and the monocyte response to infection with M. tuberculosis, including phagocytosis of M. tuberculosis, antimycobacterial activity, LL-37, human β defensin-2 and IL-10 gene expression and nitric oxide production, between type 2 diabetes mellitus patients (n = 51) and healthy volunteers (n = 38). Results Twenty-seven type 2 diabetes mellitus patients had inadequate inactive vitamin D levels (<50 nM). The percentages of M. tuberculosis phagocytosis between monocytes were similar across groups according to microscopy. Intracellular mycobacterial growth was similar in infected monocytes from both groups. However, M. tuberculosis growth was significantly higher in monocytes obtained from type 2 diabetes mellitus patients and lower vitamin D levels after 1-h (D0) and 72-h (D3) post-infection (p ≤ 0.05). LL-37, human β defensin-2 and IL-10 mRNA expression were similar between monocytes across groups; vitamin D serum levels and LL-37, human β defensin-2 and IL-10 expression were not correlated. Nitric oxide production was significantly higher in healthy volunteers than in type 2 diabetes mellitus patients with low vitamin D serum levels at D3 post-infection (p ≤ 0.05). Conclusions Our results show that monocytes from type 2 diabetes mellitus patients and low vitamin D serum levels show an impaired ability to control the intracellular growth of M. tuberculosis, which is not associated with significant decrease of LL-37 or human β defensin-2 expression. Vitamin D could be the link between diabetes and tuberculosis susceptibility. Electronic supplementary material The online version of this article (10.1186/s12879-017-2705-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- María Teresa Herrera
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, 14080, Ciudad de México, Mexico
| | - Yolanda Gonzalez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, 14080, Ciudad de México, Mexico
| | - Fernando Hernández-Sánchez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, 14080, Ciudad de México, Mexico
| | - Guadalupe Fabián-San Miguel
- Clínica del Síndrome Metabólico, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, 14080, Ciudad de México, Mexico
| | - Martha Torres
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, 14080, Ciudad de México, Mexico.
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Abstract
The increase in type 2 diabetes mellitus (DM) patients in countries where tuberculosis (TB) is also endemic has led to the reemerging importance of DM as a risk factor for TB. DM causes a 3-fold increase in TB risk and a 2-fold increase in adverse TB treatment outcomes. Given the sheer numbers of DM patients worldwide, there are now more TB patients with TB-DM comorbidity than TB-HIV coinfection. There is an urgent need to implement strategies for TB prevention and control among the millions of DM patients exposed to Mycobacterium tuberculosis. This chapter summarizes the current epidemiological, clinical, and immunological knowledge on TB and DM and their clinical and public health implications. These include the underlying mechanisms for TB risk in DM patients and their clinical and sociodemographic characteristics that distinguish them from TB patients without DM. TB-DM comorbidity is posing a new challenge for integrating the short-term care for TB with the long-term care for DM, particularly in low- and middle-income countries.
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Agarwal AK, Gupta G, Marskole P, Agarwal A. A Study of the Patients Suffering from Tuberculosis and Tuberculosis-diabetes Comorbidity in Revised National Tuberculosis Control Program Centers of Northern Madhya Pradesh, India. Indian J Endocrinol Metab 2017; 21:570-576. [PMID: 28670542 PMCID: PMC5477446 DOI: 10.4103/ijem.ijem_89_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is recognized as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. AIM This study was conducted to document the coexistence of DM and TB in persons with established TB under the Revised National Tuberculosis Control Program. TYPE OF STUDY This was a cross-sectional, descriptive observational study conducted at selected Directly Observed Therapy center in Gwalior North Central India. MATERIALS AND METHODS A total of 550 patients with confirmed diagnosis of TB and on treatment were recruited. The study participants were screened for DM and diagnoses were made on the basis of the World Health Organization criteria. Clinical parameters were compared between persons with DM and those without DM. RESULTS DM/TB co-morbidity was noted in 85 individuals and these made up 15.4% of the study population. The mean age was higher in DM patients with TB (43.4 ± 15.4 vs. 33.1 ± 16.2 years, P = 0.000); the mean duration of symptoms of TB with DM was more (124 ± 16.4 vs. 107.49 ± 10.3 days). Multinomial logistic regression analysis showed that increasing age, positive family history of diabetes, sedentary occupation, and presence of pulmonary TB were significantly associated with diabetes among TB patients. CONCLUSIONS Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB.
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Affiliation(s)
- Anil Kumar Agarwal
- Department of Community Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
| | - Ginisha Gupta
- Department of Community Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
| | - Priyesh Marskole
- Department of Community Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
| | - Anju Agarwal
- Department of Community Medicine, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India
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Kumar Nathella P, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology 2017; 152:13-24. [PMID: 28543817 DOI: 10.1111/imm.12762] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes mellitus(DM) is a major risk factor for the development of active pulmonary tuberculosis (TB), with development of DM pandemic in countries where TB is also endemic. Understanding the impact of DM on TB and the determinants of co-morbidity is essential in responding to this growing public health problem with improved therapeutic approaches. Despite the clinical and public health significance posed by the dual burden of TB and DM, little is known about the immunological and biochemical mechanisms of susceptibility. One possible mechanism is that an impaired immune response in patients with DM facilitates either primary infection with Mycobacterium tuberculosis or reactivation of latent TB. Diabetes is associated with immune dysfunction and alterations in the components of the immune system, including altered levels of specific cytokines and chemokines. Some effects of DM on adaptive immunity that are potentially relevant to TB defence have been identified in humans. In this review, we summarize current findings regarding the alterations in the innate and adaptive immune responses and immunological mechanisms of susceptibility of patients with DM to M. tuberculosis infection and disease.
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Affiliation(s)
- Pavan Kumar Nathella
- National Institutes of Health-International Centre for Excellence in Research, Chennai, India.,National Institute for Research in Tuberculosis, Chennai, India
| | - Subash Babu
- National Institutes of Health-International Centre for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Lawson L, Muc M, Oladimeji O, Iweha C, Opoola B, Abdurhaman ST, Bimba JS, Cuevas LE. Tuberculosis and diabetes in Nigerian patients with and without HIV. Int J Infect Dis 2017; 61:121-125. [PMID: 28652217 DOI: 10.1016/j.ijid.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) and HIV increase the risk of tuberculosis (TB). The frequency of DM among patients with TB with and without HIV is poorly documented in many low- and middle-income countries. METHODS This was a cross-sectional hospital-based study performed in Abuja, Nigeria. Adults with presumptive TB were screened consecutively. Sputum culture was used for TB screening and blood was used for HIV screening, as well as fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) assessment for the diagnosis of DM. HbA1c was measured using the D-10 Haemoglobin Testing System and a point-of-care test (A1C Now+ system) for comparison. Patients were classified as having DM or pre-diabetes using the D-10 reference test. RESULTS Four hundred and ten individuals had TB culture, FPG, and HbA1c results. Participants had a mean (±standard deviation) age of 37.8±12.6 years and 217 (54.8%) were male. One hundred and thirteen (27.6%) patients were culture-positive, 62 (15.1%) had DM, and 46 (11.2%) had pre-diabetes. One hundred and eighty-four (53.3%) participants were HIV-positive and 95 (51.6%) were on antiretroviral therapy (ART). Patients with pre-diabetes and DM were more likely to have TB (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.01-3.74, and OR 2.39, 95% CI 1.35-4.24, respectively). After adjustment for HIV, age, and sex, only DM was statistically associated with TB (adjusted OR (AOR) 3.10, 95% CI 1.62-5.94). HIV-negative patients with DM had a higher risk of TB (AOR 4.32, 95% CI 1.57-11.92) than HIV-positive patients with DM (AOR 3.31, 95% CI 1.29-8.54), but the difference was not statistically significant. A1C Now+ HbA1c measurements correlated poorly with the D-10 HbA1c reference test. CONCLUSION A high proportion of patients in Abuja have markers of DM and pre-diabetes at the time of TB diagnosis.
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Affiliation(s)
- Lovett Lawson
- Department of Community Medicine and Primary Healthcare, Bingham University, Karu, Nasarawa State, Nigeria; Zankli Medical Centre, Abuja, Nigeria.
| | - Magdalena Muc
- Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Olanrewaju Oladimeji
- Zankli Medical Centre, Abuja, Nigeria; University of KwaZulu-Natal, South Africa.
| | | | | | | | - John S Bimba
- Department of Community Medicine and Primary Healthcare, Bingham University, Karu, Nasarawa State, Nigeria.
| | - Luis E Cuevas
- Liverpool School of Tropical Medicine, Liverpool, UK.
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IL-6 and IL-18 cytokine gene variants of pulmonary tuberculosis patients with co-morbid diabetes mellitus and their household contacts in Hyderabad. Gene 2017; 627:298-306. [PMID: 28652186 DOI: 10.1016/j.gene.2017.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/15/2017] [Accepted: 06/22/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Association of cytokine genes reflects their susceptibility towards infection and disease in household contacts (HHC) of pulmonary tuberculosis (PTB) patients. Hyperglycemia, a common factor in diabetics might influence their risk towards mycobacterium tuberculosis infection and disease development. This study determines the association of IL-6 and IL-18 cytokine gene variants of TB patients with diabetes mellitus (TBDM) and their HHC in Hyderabad. METHODS Single nucleotide polymorphisms of IL-6 (-174 G>C and -572 G>C) and IL-18 (-137 G>C and -607 C>A) cytokine genes were genotyped by Amplification Refractory Mutation System and Restriction Fragment Length polymerase chain reaction in total of 705 subjects comprising of TBDM, their HHC, PTB, DM and Healthy controls (HC). RESULTS At IL-6 -174G>C variant, GG genotype, G allele in TBDM and TBDM HHC, at -572G>C variant, C allele in TBDM and GG haplotype in TBDM HHC were showing positive association, however DM have not shown any association at IL-6 polymorphic sites. With respect to the IL-18 gene polymorphisms, at -137 G>C variant, GG genotype was positively associated in PTB while at -607 C>A variant positive association was shown with AC genotype in TBDM, their HHC and DM; GACC diplotype in TBDM and GCGC in PTB. CONCLUSION Our findings suggest that susceptible combination of IL-6 and IL-18 cytokine genes associated with disease in the HHCs highlight their risk of inclination towards the disease.
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Owiti P, Keter A, Harries AD, Pastakia S, Wambugu C, Kirui N, Kasera G, Momanyi R, Masini E, Some F, Gardner A. Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin. Public Health Action 2017; 7:147-154. [PMID: 28695089 PMCID: PMC5493097 DOI: 10.5588/pha.16.0114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/19/2017] [Indexed: 12/19/2022] Open
Abstract
Setting: The tuberculosis (TB) clinics of five health facilities in western Kenya. Objective: To assess the prevalence and associated determinants of diabetes mellitus (DM) and pre-diabetes hyperglycaemia among adult TB patients using point-of-care DCA Vantage glycated haemoglobin (HbA1c) devices. Design: This was a cross-sectional study. Results: Of 454 patients, 272 (60%) were males, the median age was 34 years, 175 (39%) were co-infected with the human immunodeficiency virus (HIV), and the median duration of anti-tuberculosis treatment was 8 weeks; 180 (40%) patients reported at least one classical symptom suggestive of DM. The prevalence of DM (HbA1c ⩾6.5%) was 5.1% (95%CI 3.2-7.5), while that of pre-diabetes (HbA1c 5.7-6.4%) was 37.5% (95%CI 33.1-42.2). The number needed to screen (NNS) was 19.6 for DM and 2.7 for pre-diabetes. Combined, 42.6% (95%CI 38.0-47.3) of the patients had either pre-diabetes or DM (NNS 2.3). Seven of the 23 patients with DM knew their prior DM status. Higher rates of DM were associated with age ⩾40 years and a family history of DM, but not obesity, type of TB, HIV status or suggestive symptoms. Conclusions: High rates of pre-diabetes and DM were found in adult TB patients. This study supports the need for routine screening of all patients with TB for DM in Kenya.
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Affiliation(s)
- P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Keter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - S Pastakia
- Purdue University College of Pharmacy, West Lafayette, Indiana, USA
- Moi University School of Medicine, Eldoret, Kenya
| | | | - N Kirui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - G Kasera
- Ministry of Health, Nairobi, Kenya
| | - R Momanyi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - E Masini
- Ministry of Health, Nairobi, Kenya
| | - F Some
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
| | - A Gardner
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Indiana University School of Medicine, Bloomington, Indiana, USA
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Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLoS One 2017; 12:e0175925. [PMID: 28430796 PMCID: PMC5400500 DOI: 10.1371/journal.pone.0175925] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health concern. There is mounting evidence from different countries on the burden of TB and DM comorbidity. The objective of this systematic review was to summarize the existing evidence on prevalence and associated/risk factors of TBDM comorbidity at global and regional levels. Methods Ovid Medline, Embase, Global health, Cochrane library, Web of science and Scopus Elsevier databases were searched to identify eligible articles for the systematic review. Data were extracted using standardized excel form and pilot tested. Median with interquartile range (IQR) was used to estimate prevalence of TBDM comorbidity. Associated/risk factors that were identified from individual studies were thematically analyzed and described. Results The prevalence of DM among TB patients ranged from 1.9% to 45%. The overall median global prevalence was 16% (IQR 9.0%-25.3%) Similarly, the prevalence of TB among DM patients ranged from 0.38% to 14% and the overall median global prevalence was 4.1% (IQR 1.8%-6.2%). The highest prevalence of DM among TB patients is observed in the studied countries of Asia, North America and Oceania. On the contrary, the prevalence of TB among DM patients is low globally, but relatively higher in the studied countries of Asia and the African continents. Sex, older age, urban residence, tobacco smoking, sedentary lifestyle, poor glycemic control, having family history of DM and TB illness were among the variables identified as associated/risk factors for TBDM comorbidity. Conclusion This systematic review revealed that there is a high burden of DM among TB patients at global level. On the contrary, the global prevalence of TB among DM patients is low. Assessing the magnitude and risk/associated factors of TBDM comorbidity at country/local level is crucial before making decisions to undertake TBDM integrated services.
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Affiliation(s)
- Mahteme Haile Workneh
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- * E-mail:
| | - Gunnar Aksel Bjune
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Firănescu AG, Popa A, Roşu MM, Protasiewicz DC, Popa SG, Ioana M, Moța M. The Diabetes-Tuberculosis Co-Epidemic: The Interaction between Individual and Socio-Economic Risk Factors. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2017. [DOI: 10.1515/rjdnmd-2017-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Worldwide, tuberculosis (TB) is a major cause of morbi-mortality, about 30% of the population having a Mycobacterium tuberculosis infection. Patients with diabetes mellitus (DM) have a threefold increased risk of developing the disease. The prevalence of DM is rapidly increasing, especially in countries with low and middle income, where TB incidence is also increased, thus baffling the efforts for TB control. The DM-TB co-epidemic is more frequent in married, older men, with reduced level of education, low income, without a steady job, with lifestyle habits such as alcohol consumption, smoking, sedentarism, living in an urban environment, in crowded areas, in insanitary conditions. These patients have a higher body mass index (BMI) compared with those without DM and frequently present family history of TB, family history of DM, longer duration of DM and reduced glycemic control. TB associated with DM is usually asymptomatic, more contagious, multidrug resistant and is significantly associated with an increased risk of therapy failure, relapse and even death. Thus, the DM-TB comorbidity represents a threat to public health and requires the implementation of urgent measures in order to both prevent and manage the two diseases.
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Affiliation(s)
- Adela-Gabriela Firănescu
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Adina Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
| | - Maria-Magdalena Roşu
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Diana Cristina Protasiewicz
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Mihai Ioana
- University of Medicine and Pharmacy, Craiova, Romania
| | - Maria Moța
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
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