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Screening for Pulmonary Tuberculosis

Screening high-risk elderly diabetic patients for pulmonary tuberculosis might be a potential way to reduce tuberculosis incidence…

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Many studies in the past have focused on the effects of diabetes on tuberculosis infection. Having diabetes increases the risk of tuberculosis infection as well as the risk of diabetes complications. Moreover, multi-drug resistant tuberculosis may also develop. This study’s goal was to examine the effects of active screening of tuberculosis in elderly type 2 diabetic patients and to determine other possible risk factors.

This single-center, cross-sectional study was conducted in Taiwan. A total of 3,087 type 2 diabetic patients with ≥65 years old were selected inpatient and outpatient. They received screening that included a questionnaire with basic medical information, laboratory tests within 3 months of enrolled date, and chest X-ray within 6 months of enrolled date. If tuberculosis was suspected, the patients were referred to appropriate outpatient clinics for further evaluation, diagnosis, and treatment. Pulmonary tuberculosis was then confirmed using sputum culture. Some statistical tests were used, such as Student’s t-test, Chi-square test, or Fisher’s exact test, and univariate/multiple logistic regression models.

A total of 7 patients screened positive for pulmonary tuberculosis. Another 5 patients were being under anti-tuberculosis treatment during this screening program. The tuberculosis prevalence rate was 3.89% (12/3,087). Several factors were associated with an increased risk of tuberculosis, such as male gender, having a smoking history, liver cirrhosis, or subjective body weight loss. After the adjustment, subjective body weight loss (OR: 6.635 [95% CI: 2.096-21.007]), smoking (OR: 3.981 [95% CI: 1.246-12.718]), and liver cirrhosis (OR: 10.307 [95% CI: 2.108-50.395]) were shown to be independent risk factors of pulmonary tuberculosis. Some characteristics were similar among patients who have active tuberculosis or tuberculosis history; for example, male gender, lower body mass index (BMI), smoking, alcohol consumption, family history of tuberculosis, higher low-density lipoprotein (LDL), and less hypertension. There was no significant difference in the HbA1C levels between tuberculosis and non-tuberculosis group.

In conclusion, several independent risk factors were associated with pulmonary tuberculosis in elderly diabetic patients, such as subjective body weight loss, smoking, and liver cirrhosis. Active screening program should be implemented to detect, diagnose, and treat these high-risk patients. However, further studies with longer duration are needed to confirm the results.

Practice Pearls:

  • Elderly diabetic patients with complaints of body weight loss should be screened for tuberculosis.
  • Patients in tuberculosis group had lower levels of total cholesterol, LDL, and high-density lipoprotein (HDL) level. This might be due to increased lipid metabolism during inflammatory or infection status for immune response.
  • Among adult tuberculosis patients, the percentages of symptoms reported for cough more than 2 weeks, chest pain, anorexia, and body weight loss were 48.2%, 41.0%, 40.6%, and 44.5%, respectively.

Yung-Hsiang Lin, Chia-Pei Chen, Pao-Ying Chen, Jui-Chu Huang, Cheng Ho, Hsu-Huei Weng, Ying-Huang Tsai, and Yun-Shing Peng. "Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital." BMC Public Health. 2015;15:3.