Tuberculosis and diabetes

Aims and objectives: Diabetic patients are considered at increased risk of infections, including tuberculosis. The purpose of this work was to analyze the epidemiological, clinical, diagnostic, therapeutic characteristics, aggravating factors and evolution in patients with pulmonary tuberculosis and diabetes. Methods: This retrospective study included 42 patients with pulmonary tuberculosis and diabetes, followed in Farhat Hached health center of Sfax and whose bacteriological diagnosis was confirmed in the hygiene laboratory of Hedi Chaker university hospital between 2009 and 2015. Results: Diabetes affects 10.8% of patients with pulmonary tuberculosis. The mean age was 55.5 years and the sex ratio were 1.2. Diabetes occurs before tuberculosis in 88% of cases. The majority of patients had type 2 diabetes, of which 23.8% required insulin treatment. Anti-diabetic treatment was modified in 21.4% of cases due to poor glycemic control. The diagnosis of pulmonary tuberculosis was based on clinical, radiological, histological data and microbiological analysis. Cough was the most frequent symptom (88.1%). Pulmonary tuberculosis patients with diabetes were more likely to have pulmonary cavities (66.7%) and apical lesions (76.1%). Smear was positive in 85.7%. After 2 months of treatment, only 50% of the positive smears became negative. Tuberculosis treatment lasted more than 6 months in 66.7%. Most of patients had a favorable evolution (90.5%), 4.7% of cases had relapsed and one patient died. Smoking (52%), family history of pulmonary tuberculosis (47.6%) and high blood pressure (30.9%) were the most frequent risk factors in these patients. Conclusion: The bidirectional association between pulmonary tuberculosis and diabetes due to the modification of the clinical presentation and evolution under treatment makes patients more fragile requiring a better medical care.