Pulmonary tuberculosis and diabetes mellitus co-morbidity in a nigerian tertiary hospital

Background: Pulmonary tuberculosis (PTB) and Diabetes Mellitus (DM) co-morbidity is an increasing problem in Nigeria. Patients may present with atypical clinical findings compared with PTB-only patients, posing a diagnostic challenge. Objective: To determine the prevalence of PTB-DM comorbidity at Nnamdi Azikiwe University Teaching Hospital NAUTH Nnewi, and identify the clinico-radiographic differences between the co-morbid group and the PTB-only group. Methods: 120 newly diagnosed, consenting PTB patients were recruited for the study. Demographic and clinical data were obtained using a simplified questionnaire. PTB diagnosis was defined as positive sputum smear microscopy for acid fast bacilli in at least 2 sputum specimens in patients with suggestive symptoms of PTB. DM was diagnosed using random blood glucose of greater than or equal to 11.1mmol and fasting blood glucose greater than or equal to 7.0mmol/l. Chest radiographs were performed for the patients and assessed for features that are suggestive of pulmonary tuberculosis. The outcome was analysed using appropriate statistics. The primary outcome for the study is the prevalence of the co-morbidity among the newly diagnosed PTB patients. Results: Co-morbidity of PTB-DM was confirmed in 22/120 (18.3%) of the recruited patients. New DM diagnosis was made in 5/22 (22.7%) of the population. Co-morbid patients were found to be significantly older and likely to be more hypertensive (chi(2)=15.94, p<0.001) than the PTB-only group. Whilst cough and weight loss were the most common symptoms, we found that anorexia was significantly higher in the co-morbid group (chi(2)=3.85, p = 0.016). We found no difference in radiographic characteristics between the two groups. Conclusion: The prevalence of PTB-DM co-morbidity in this study was high and confirmed an increasing trend when compared with previous literature. PTB presentation represents an opportunity to screen and initiate treatment for non-communicable diseases such as diabetes mellitus.