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15 August 2007

Volume 45, Number 4
Clinical Infectious Diseases 2007;45:428–435
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4504-0004$15.00
DOI: 10.1086/519841
MAJOR ARTICLE

The Effect of Type 2 Diabetes Mellitus on the Presentation and Treatment Response of Pulmonary Tuberculosis

Bachti Alisjahbana,1

Edhyana Sahiratmadja,3

Erni J. Nelwan,4

Anugrah Maya Purwa,1

Yana Ahmad,1

Tom H. M. Ottenhoff,5

Ronald H. H. Nelwan,4

Ida Parwati,2

Jos W. M. van der Meer,6 and

Reinout van Crevel6

1Internal Medicine and 2Clinical Pathology Department, Medical Faculty, Padjadjaran University, Bandung, and 3Eijkman Institute of Molecular Biology and 4Infectious Disease Working Group, Medical Faculty, University of Indonesia, Jakarta, Indonesia; and 5Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, and 6Department of Internal Medicine, Radboud University Nijmegen Medical Center, The Netherlands

Background.Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB), and with the increasing prevalence of type 2 DM in less developed regions, many patients with TB will have concomitant DM. Presently, little is known about the effect of DM on the clinical presentation and treatment outcome of TB.

Methods.In an urban setting in Indonesia, 737 patients with pulmonary TB were screened for DM and were followed up prospectively during TB treatment. Clinical characteristics and outcome were compared between patients with TB who had DM and patients with TB who did not have DM.

Results.DM was diagnosed in 14.8% of patients with TB and was associated with older age and a greater body weight. On presentation, diabetic patients with TB had more symptoms but had no evidence of more‐severe TB. After 2 months, results of sputum microscopic examination was more often positive in diabetic patients (18.1% vs. 10.0%). After 6 months, 22.2% of cultured sputum specimens from diabetic patients were positive for Mycobacterium tuberculosis (adjusted odds ratio, 7.65; ).

Conclusion.DM seems to have a negative effect on the outcome of TB treatment. The underlying mechanisms for the different response to treatment in diabetic patients with TB must be explored. Screening for DM and subsequent glycemic control may improve the outcome of TB treatment.

Received 9 November 2006; accepted 24 March 2007; electronically published 5 July 2007.

  • (See the editorial commentary by Restrepo on pages 436–8)

Reprints or correspondence: Dr. Reinout van Crevel, Dept. of Internal Medicine, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ().

Cited by

C. S. WANG, C. J. YANG, H. C. CHEN, S. H. CHUANG, I. W. CHONG, J. J. HWANG, M. S. HUANG. (2009) Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiology and Infection 137:02, 203
Online publication date: 1-Mar-2009.
CrossRef
May Young Lin, Tom H.M. Ottenhoff. (2008) Highlight: 3 rd Semmering Conference 2007. Biological Chemistry 389:5, 497-511
Online publication date: 1-Jun-2008.
CrossRef
Blanca I. Restrepo. (2007) Editorial Commentary: Convergence of the Tuberculosis and Diabetes Epidemics: Renewal of Old Acquaintances. Clinical Infectious Diseases 45:4, 436-438
Online publication date: 15-Aug-2007.
Citation-Full Text-PDF Version (162 kB)
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