Background:
The prevalence of pulmonary tuberculosis infections had increased among the
type 2 Diabetes Mellitus (DM) patients in India, although the biological basis underlying this susceptibility
remains poorly characterized. Based on the symptom’s, chest X-rays and their correlation with
clinical and diagnostic parameters, we had suspected diabetic-tuberculosis co-infections. As Chest XRay
plays a vital role in the identification of pulmonary tuberculosis infections, we emphasized more on
it. Chest X-ray features included were; (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal
lymphadenopathy and extent of lesions) such features were analyzed to identify associations
with biological/clinical parameters through univariate and multivariate logistic regression.
Method:
The study was carried out in diabetic type 2 patients suspected with pulmonary tuberculosis
infections, Warangal, India. Spoligotyping was used for identification, detection and characterization of
M. tuberculosis complex bacteria in clinical samples. This method is based on polymerase chain reaction
(PCR) amplification of a highly polymorphic direct repeat locus in the M. tuberculosis genome. It
is helpful in detecting causative bacteria and in providing epidemiologic information on genotyping
strain identities.
Results:
Based on the chest X-Ray of 200 diabetic patients suspected with pulmonary infections, we
found 26 infiltrates, 30 cavitation, 28 miliary shadows, 35 pleural effusion, 46 mediastinal
lymphadenopathy and 35 were confirmed for the extent of lesions, which supported us to further screen
for pulmonary tuberculosis of 200 subjects tested, 113 were males, 85 were females and 2 were children.
All 200 subjects were tested for pulmonary tuberculosis, 36 were positive by smear microscopy
and 20 were culture positive. Phenotypic and genotypic variations were found for all the 20 identified
clinical isolates, by conventional and molecular methods of 20 clinical isolates, 4 MDR-TB were identified
based on the Drug Susceptibility Test for first-line drugs. Of 20 clinical isolates, we took 10 clinical
isolates (4-were MDR-TB and 6- were MTB) and 1- was control sample of H37RV used for spoligotyping
and showed different patterns Bejing (1) and Lineages of East Asian, of family EA13(2) and Lineages
of Indo-Oceanic, of family LAM1(1) and Lineages of Euro-American and 6 were found to be
MTB of family 33(2) and Lineages of Indo-Oceanic, of family CAS(4) and Lineages of Un-known
family. CAS (Central Asian) of M.tuberculosis strains showed more prevailing spoligotype pattern in
Diabetic Pulmonary Tuberculosis patients.
Conclusion:
Implementing such a method in clinical settings would be useful in surveillance of tuberculosis
transmission and in interventions to prevent further spread of this disease among the Diabetic
Pulmonary Tuberculosis co-infections.
Pulmonary tuberculosis patients with diabetes mellitus have a more severe degree of chest X-ray compared to pulmonary tuberculosis patients without diabetes mellitus
