Study of the incidence of different types of tuberculous lesion in association with diabetes mellitus in Indian patients

Abstract

Background: Tuberculosis (TB) is one of the most common infectious diseases worldwide.  It is well known that diabetes mellitus (DM) impairs the immunity of patients and therefore is an independent risk factor for infections such as TB. Hence keeping all above things in mind we had undertaken this study with following aims and objectives: to find out the incidence of different types of tuberculosis in patients suffering from diabetes mellitus; to prevent early mortality and morbidity caused by tuberculosis and early diagnosis and treatment of diabetes mellitus in patients of tuberculosis and vice-versa. Materials & Methods: In the present work a total number of 100 (hundred) patient were selected in which patients had history of diabetes mellitus and having complaints of cough with productive sputum for more than four weeks. Sputum examination for A.F.B, sputum culture examination, Skiagram of the chest PA view, tuberculin skin test, ELISA for mycobacterium tuberculosis, biochemical, cytological examination and culture of ascitic, pleural, pericardial and cerebrospinal fluid. Others supportive investigations  were complete blood examination, ESR, USG of abdomen, echocardiography, C.T. Scan of Brain, Spine, Abdomen etc. and tissue biopsy – by fine needle aspiration of affected side was taken and cultured. Results: About 100 cases of diabetes mellitus were taken from indoor and outdoors in Rajendra Institute of Medical Sciences, Ranchi of these patients 20 were found with tuberculous lesion. In 20 diabetic tuberculosis patients, 11 were male and 9 were female. In these patients, 16 were belonging to rural area and 4 were from urban area. Extra pulmonary tuberculosis was found in 14 patients and pulmonary tuberculosis in 6 patients. The incidence of tuberculous infection is associated with more in type 2 diabetes mellitus than type 1 diabetes mellitus, 17 & 3 cases respectively. The most common clinical feature was cough with or without expectoration, than fever and weakness. Pleural effusion is the most common extra pulmonary tuberculous lesion. Most of the tuberculous lesions are diagnosed by Chest X-Ray PA-view. In diabetic pulmonary tuberculous lesion, 45% cases are found in advanced stage.  Conclusion: This study shows the incidence of tubercolous infection in diabetes mellitus in gradually increasing. Extra pulmonary types of tuberculosis are more in diabetic patients. Rural populations are more prone to be infected with tuberculosis. The future studies will within corborate or contradict the present finding and thereby strengthen the observation made in the present study.

Keywords: Pulmonary and extra pulmonary tuberculosis, diabetes mellitus, association, incidence, diagnostic tests, mortality