CLINICAL DETERMINANTS OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS

Abstract

SUMMARY AND CONCLUSION T his study was conducted on two groups of patients, group of diabetic patients and tuberculosis (DM-TB) group (80 patients), and group of diabetic patients admitted because of other chest problems rather than TB (DM) group (80 patients). All patients were admitted in Abassia chest hospital from Jun 2014 to July 2015. All patients were subjected to full history taking, clinical examination, laboratory investigations and radiological examination. The aim of the current study is to assess the clinical determinants of development of pulmonary tuberculosis among diabetic patients. BMI was found to be highly statistical significant lower in DM-TB group than DM group. According to special habits of medical importance; Banjo, Hashish and Tramadol were found to be statistically significant as a risk factor for TB. The current study showed that none of co-morbid diseases were found to be significant between the two groups. Uncontrolled diabetes was found to be statistically significant for Tuberculosis; As DM-TB group had higher rates of fasting blood Glucose, post prandial blood glucose, and HA1c. Also DM-TB group patients used to take a higher dose of insulin than DM group patients before and after admission. DKA and LRTIs were found to be statistically significant higher in DM-TB group, reflecting a state of uncontrolled diabetes and decreased immunity in this group. Regarding to laboratory investigations; hemoglobin concentration was significantly lower in DM-TB group, on the other hand, ESR and platelets count were found to be significantly higher in the DM-TB group. Total plasma proteins and serum Albumin were found to be significantly lower in DM-TB group, reflecting a state of malnutrition and wasting. According to radiological findings in DM-TB group; bilateral affection was found in 42.5% of cases, lower zone(s) affection was found in 21.25 % of cases, upper lung zone(s) affection was found in 22.5 %, also according to pattern of lesion; cavitary lesions were found in 32.5 % of cases, while nodular pattern was found in 43.75% of cases. This study has confirmed that the symptoms of TB do not differ from diabetics and non-diabetic patient.

From the current study it could be concluded that the factors determinant of pulmonary tuberculosis among diabetics are: 1- Weight loss and decreased BMI. 2- Drug addiction. 3- Uncontrolled diabetes (higher fasting and post prandial blood glucose levels). 4- Higher rates of HA1c (mean 9.88 ± 2.030). 5- Increased insulin requirements (mean 54.11 ± 19.78). 6- Anemia. 7- Higher ESR 8- Higher platelets count. 9- Decreased serum proteins and serum albumin.