Impact of Diabetes Mellitus on the Presentation and Response to Treatment of Adults With Pulmonary Tuberculosis in Qatar

Abstract Background Persons with diabetes mellitus (DM) have a 3-fold increased risk of tuberculosis (TB). Atypical radiographic findings and differences in bacteriologic response during anti-TB treatment have been reported in earlier studies; however, the findings have varied. We evaluated the effect of DM on manifestations and response to treatment in adults with pulmonary TB in Qatar. Methods The impact of DM on the clinical and radiographic presentations of pulmonary TB and bacteriologic response during anti-TB treatment was evaluated between January 2007 and December 2011, comparing patients with and without DM. This is a retrospective unmatched case-control study conducted at a large national hospital. Cases and controls were randomly selected from patients diagnosed with pulmonary TB over a 5-year period. Sputum culture conversion was assessed after 2 months of anti-TB treatment. Results Clinical symptoms were similar between patients with and without DM. Patients with DM had a higher initial sputum acid-fast bacillus (AFB) smear grade and were less likely to have cavitary lesions on initial chest radiographs than patients without DM. Of 134 adults with DM and TB, 71 (53%) remained sputum culture positive after 2 months of anti-TB treatment, compared with 36 (27%) patients without DM. Conclusions DM was associated with atypical radiographic findings and delayed sputum culture conversion at 2 months in adults with pulmonary TB in Qatar. Increased health education of patients with DM about symptoms of TB, low thresholds for evaluation for active TB, and close monitoring of bacteriologic response to treatment among patients with TB and DM are warranted.

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764. Impact of Diabetes Mellitus on the Presentation and Response to Treatment of Adults With Pulmonary Tuberculosis in Qatar

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.771 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S274-S274

Author(s):

Khalid M Dousa ◽

Abdelrahman Hamad ◽

Hussam Alsoub ◽

Abdel-Naser Elzouki ◽

Mahmoud I Alwakeel ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Lower Lobe ◽

Sputum Culture ◽

Response To Treatment ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Increased Risk ◽

Culture Conversion

Abstract Background Persons with diabetes mellitus (DM) have a 3-fold increased risk of TB. Vitamin D deficiency also is associated with a 4-fold increase in risk of progression of TB from latent TB infection to active TB. Qatar is an oil rich country with high prevalence of diabetes, obesity, and vitamin D deficiency. We aimed to evaluate the effect of diabetes mellitus on manifestations and response to treatment in adults with DM and TB. Methods Retrospective national hospital-based study of adult from January 2007 to December 2011, comparing TB-infected patients with and without DM. Results Of 134 adults with DM and TB, 62 (47%) became culture negative after 8 weeks of anti-TB treatment compared with 84 (72%) patients without DM. Patients with DM had more frequent lower lobe disease (28% vs. 17%, P = 0.03). Week 8 sputum culture conversion did not differ between patients by the degree of dysglyemia at time of diagnosis and onset of anti-TB treatment (70% vs. 46%, P = 0.09). Conclusion Diabetes mellitus was associated with delayed sputum culture conversion at two month and atypical radiological findings in adults with pulmonary TB in Qatar. Glycemic control had no effect on week-8 sputum culture conversion. Disclosures All authors: No reported disclosures.

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The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study

Respiratory Research ◽

10.1186/s12931-019-1256-y ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Jin Hwa Song ◽

Seo-Young Yoon ◽

Tae Yun Park ◽

Eun Young Heo ◽

Deog Kyeom Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Treatment Duration ◽

Treatment Interruption ◽

Sputum Culture ◽

Drug Induced ◽

Pulmonary Tb ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Total Treatment ◽

Culture Conversion

Abstract Background There are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment. We explored the effects of DIH on the clinical course and outcomes of pulmonary TB. Methods In this retrospective cohort study, we included patients with culture-proven pulmonary TB treated in a tertiary hospital from 2013 to 2016. DIH was defined as proposed by the official American Thoracic Society statement. We compared the clinical outcomes of DIH and non-DIH patients. Results Between January 1, 2013 and December 31, 2016, a total of 168 TB patients were included, and 20 (11.9%) were diagnosed with DIH. These patients were significantly older, had a higher Charlson Comorbidity Index score, exhibited more chronic liver disease, included more chronic alcoholics, and had a lower body mass index than non-DIH patients. We found no significant differences between DIH and non-DIH patients in the 2-month sputum culture conversion rate, the time to sputum culture conversion, treatment outcomes, or total treatment duration. However, the ratio of treatment interruption time to total treatment duration and the proportion of hepatotonic users were significantly higher among DIH patients. Conclusion DIH development during TB treatment does not significantly affect the clinical outcomes of pulmonary TB. However, treatment interruption caused by DIH may increase the risks of future relapse and acquired resistance. Further study is needed.

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Corticosteroid Effects on Sputum Culture in Pulmonary Tuberculosis: A Meta-Regression Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu020 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 11

Author(s):

Robert S. Wallis

Keyword(s):

Regression Analysis ◽

Sputum Culture ◽

Therapeutic Effects ◽

Corticosteroid Dose ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Meta Regression ◽

Anti Inflammatory ◽

Meta Regression Analysis ◽

Culture Conversion

Abstract Objectives. There is increasing interest in the potential role of adjunctive anti-inflammatory therapy to accelerate tuberculosis (TB) treatment. Sputum culture conversion is an important biomarker predictor of durable TB cure. Methods. This study used meta-regression analysis to examine the relationship between corticosteroid dose and sputum culture conversion, using published data from controlled clinical trials including 1806 corticosteroid-treated TB patients. Results. Linear models with 2 or 3 variables, including corticosteroid dose and the proportion of culture positive control subjects, predicted therapeutic benefit of corticosteroids at 1 and 2 months. The 3-variable model predicted that 134 mg of prednisolone per day, given together with standard 4-drug TB chemotherapy, would reduce the proportion of positive culture at 2 months from 15% to 2%. The estimate accounts for a 50% reduction in steroid exposure due to rifampin. A proportion of 2% of subjects with positive cultures at 2 months has been proposed as a target for new 4-month TB regimens. Conclusions. These positive findings must be tempered by recognition that the metabolic and cardiovascular risks of corticosteroids administered at this dose for this duration are unlikely to be acceptable when examined from a patient-level benefit-risk perspective. In future research studies to shorten TB treatment, biologic anti-inflammatory therapies with similar therapeutic effects but superior safety profiles should be considered.

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Polymorphisms in the vitamin D receptor gene are associated with reduced rate of sputum culture conversion in multidrug-resistant tuberculosis patients in South Africa

10.1101/132852 ◽

2017 ◽

Author(s):

Matthew J Magee ◽

Yan V. Sun ◽

James CM Brust ◽

N. Sarita Shah ◽

Yuming Ning ◽

...

Keyword(s):

South Africa ◽

Vitamin D ◽

Multidrug Resistant ◽

Sputum Culture ◽

Vdr Gene ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Genomic Analyses ◽

Mdr Tb ◽

Culture Conversion

AbstractBackgroundVitamin D modulates the inflammatory and immune response to tuberculosis (TB) and also mediates the induction of the antimicrobial peptide cathelicidin. Deficiency of 25-hydroxyvitamin D and single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene may increase the risk of TB disease and decrease culture conversion rates in drug susceptible TB. Whether these VDR SNPs are found in African populations or impact multidrug-resistant (MDR) TB treatment has not been established. We aimed to determine if SNPs in the VDR gene were associated with sputum culture conversion among a cohort of MDR TB patients in South Africa.MethodsWe conducted a prospective cohort study of adult MDR TB patients receiving second-line TB treatment in KwaZulu-Natal province. Subjects had monthly sputum cultures performed. In a subset of participants, whole blood samples were obtained for genomic analyses. Genomic DNA was extracted and genotyped with Affymetrix Axiom Pan-African Array. Cox proportional models were used to determine the association between VDR SNPs and rate of culture conversion.ResultsGenomic analyses were performed on 91 MDR TB subjects enrolled in the sub-study; 60% were female and median age was 35 years (interquartile range [IQR] 29-42). Smoking was reported by 21% of subjects and most subjects had HIV (80%), were smear negative (57%), and had cavitary disease (55%). Overall, 87 (96%) subjects initially converted cultures to negative, with median time to culture conversion of 57 days (IQR 17-114). Of 121 VDR SNPs examined, 10 were significantly associated (p<0.01) with rate of sputum conversion in multivariable analyses. Each additional risk allele on SNP rs74085240 delayed culture conversion significantly (adjusted hazard ratio 0.30, 95% confidence interval 0.14-0.67).ConclusionsPolymorphisms in the VDR gene were associated with rate of sputum culture conversion in MDR TB patients in this high HIV prevalence setting in South Africa.Author contributionsMJM, YVS, JCMB, SS, and NRG conceived and designed the study and drafted the initial manuscript. MJM, YVS, YN, and QH performed the data analyses. All authors contributed to interpretation of the data, revised the manuscript, and approved the final version.The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC). The use of trade names and commercial sources is for identification only and does not imply endorsement by the CDC.

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Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis

10.21203/rs.3.rs-41997/v2 ◽

2020 ◽

Author(s):

Naoki Takasaka ◽

Yoshitaka Seki ◽

Ikumi Fujisaki ◽

Shota Uchiyama ◽

Sachi Matsubayashi ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Pathological Finding ◽

Sputum Culture ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Conversion Rates ◽

Increased Risk ◽

Male Patients ◽

The Impact ◽

Culture Conversion

Abstract Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥1 based on low attenuation area < -950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [ interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p<0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [ hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p=0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p=0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p<0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p=0.015 and 84.21% vs 60.98%; p=0.021, respectively). Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.

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Diabetes Mellitus, Smoking Status, and Rate of Sputum Culture Conversion in Patients with Multidrug-Resistant Tuberculosis: A Cohort Study from the Country of Georgia

PLoS ONE ◽

10.1371/journal.pone.0094890 ◽

2014 ◽

Vol 9 (4) ◽

pp. e94890 ◽

Cited By ~ 18

Author(s):

Matthew J. Magee ◽

Russell R. Kempker ◽

Maia Kipiani ◽

Nestani Tukvadze ◽

Penelope P. Howards ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Smoking Status ◽

Multidrug Resistant ◽

Sputum Culture ◽

Sputum Culture Conversion ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Country Of Georgia ◽

Culture Conversion

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Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01325-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Naoki Takasaka ◽

Yoshitaka Seki ◽

Ikumi Fujisaki ◽

Shota Uchiyama ◽

Sachi Matsubayashi ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Pathological Finding ◽

Sputum Culture ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Conversion Rates ◽

Increased Risk ◽

Male Patients ◽

The Impact ◽

Culture Conversion

Abstract Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.

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Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis

10.21203/rs.3.rs-41997/v1 ◽

2020 ◽

Author(s):

Naoki Takasaka ◽

Yoshitaka Seki ◽

Ikumi Fujisaki ◽

Shota Uchiyama ◽

Sachi Matsubayashi ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Pathological Finding ◽

Sputum Culture ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Conversion Rates ◽

Increased Risk ◽

Male Patients ◽

The Impact ◽

Culture Conversion

Abstract Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB).Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥1 based on low attenuation area < -950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment.Results Mycobacterial median time to culture conversion (TCC) in 39 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 40 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p<0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.50; 95% confidence interval (CI): 1.24–5.04; p=0.011), cavities (HR: 2.20; 95% CI: 1.22–3.97; p=0.009) and baseline time to TB detection within 2 weeks (HR: 2.85; 95% CI: 1.60–5.08; p<0.0001). Cavities were more often identified by CT in PTB patients with than without emphysema (69.2% vs 45.0%; p=0.03).Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.

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