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  • Title: Prevalence and clinical features of tuberculosis in Ethiopian diabetic patients.
    Author: Feleke Y, Abdulkadir J, Aderaye G.
    Journal: East Afr Med J; 1999 Jul; 76(7):361-4. PubMed ID: 10520361.
    Abstract:
    OBJECTIVE: To determine the prevalence and clinical characteristics of tuberculosis (TB) in diabetic patients. DESIGN: This study was a cross-sectional survey based on the retrospective analysis of data on tuberculosis in diabetic patients. SETTINGS: The study was conducted at Endocrinology and Metabolism Unit of the Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia. SUBJECTS: Seventy-eight cases of tuberculosis among 1352 diabetic patients were included from September 1989 to 1996. MAIN OUTCOME MEASURES: Clinical evaluation, chest x-ray, acid fast bacilli (AFB) in sputum or measures tissue and histopathologic characteristic of biopsy specimens. RESULTS: Seventy-eight cases of TB were identified among 1352 diabetic patients giving a prevalence of 5.8%. Among 1352 diabetic patients, 713 (52.7%) were males, 639 (43.3%) were females, 619 (45.8%) were IDDM and 733 (54.2%) were NIDDM. The mean age of the 71 TB patients whose records could be retrieved was 34.0 +/- 11.9 years, 42(59%) were males, 29 (41%) were females. Fifty-four (76.1%) were IDDM and 17(23.9%) were NIDDM, 17 of the IDDM had clinical characteristics of malnutrition-related diabetes mellitus (MRDM), 36 (56%) of 71 patients were admitted for management. The three most common symptoms of tuberculosis were fever (80.5%), sweating (80.4%) and cough (70.5%). Twenty six (36.6%) of 71 cases were positive for AFB and six (8.5%) were seropositive for HIV. Fifty-six (78.9%) had pulmonary,eight (11.2%) had extrapulmonary and seven(9.8%) had disseminated TB. Forty-eight of 53 abnormal chest x-ray showed unilateral involvement. Thirty-eight of 41 (53.6%) had completed TB treatment, relapse occurred in seven (9.8%), eight (11.2%) are currently on treatment, 13 (18.3%) were lost to follow up, four (5.6%) defaulted and three (4.2%) died. The relative risk of developing TB in IDDM and NIDDM patients was being 26 times and seven times than the general population respectively. CONCLUSION: The prevalence of tuberculosis in the diabetic population is high and this warrants a prospective study to determine association between pulmonary tuberculosis and diabetes. This retrospective, cross-sectional analysis examines the prevalence and clinical characteristics of tuberculosis (TB) in Ethiopian diabetic patients. Using the records of 1352 patients seen at the Endocrinology and Metabolism Unit of the Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia, 78 cases (5.8%) of TB were identified. Diagnosis of the disease includes clinical evaluations, chest x-ray, and detection of acid-fast bacilli (AFB) in the sputum or measures tissue and histopathologic characteristics of biopsy specimens. Prevalence was 52.7% among males, 54.25% among those with non-insulin-dependent diabetes mellitus (NIDDM), 47.3% among females, and 45.8% among those with insulin-dependent diabetes mellitus (IDDM). The mean age of 71 patients with TB was 34 +or- 19 years (14-85 years); 76.0% were IDDM and 23.9% were NIDDM patients. 17 of the IDDM patients also had clinical characteristics similar to those of malnutrition-related diabetes mellitus. The most frequent symptoms of TB included fever (80.5%), sweating (80.5%), and cough (76%); 78.9% of patients suffered from pulmonary, 11.2% from extrapulmonary, and 9.9% from disseminated TB. On the other hand, chest X-ray reports revealed that 48 of the patients had unilateral or multiple lobe involvement and 5 had bilateral involvement. Of the 71 patients, 38 were able to complete antituberculosis treatment, 4 patients defaulted, 7 had relapse, 6 were still in treatment, 13 were lost to follow-up, and 3 died. In conclusion, this study confirmed the 26- and 7-fold risk of developing TB among IDDM and NIDDM patients, respectively.
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