☆ 4.7 Article

Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES (2013)

Journal

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES

Volume 17, Issue 6, Pages E404-E412

Publisher

ELSEVIER SCI LTD

DOI: 10.1016/j.ijid.2012.12.029

Keywords

Tuberculosis; Multi-drug resistance; Diabetes; Peru

Funding

NIAID [K23 AI054591-01A2]
Bill & Melinda Gates Foundation
Heiser Foundation
Infectious Diseases Society of America
US Centers for Disease Control and Prevention (US CDC)

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Abstract

Objectives: Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. Methods: During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. Results: Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) > 18.5 kg/m(2) (p < 0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. Conclusions: Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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Genomic-based surveillance reveals high ongoing transmission of multi-drug-resistant Mycobacterium tuberculosis in Southern Brazil

Richard Steiner Salvato, Ana Julia Reis, Sun Hee Schiefelbein, Michael Andres Abril Gomez, Stephanie Steiner Salvato, Larissa Vitoria da Silva, Elis Regina Dalla Costa, Gisela Unis, Claudia Fontoura Dias, Miguel Viveiros, Isabel Portugal, Andrea von Groll, Pedro Eduardo Almeida da Silva, Afranio Lineu Kritski, Joao Perdigao, Maria Lucia Rosa Rossetti

Summary: Genomic-based surveillance has proven to be a powerful tool for controlling tuberculosis drug resistance, with lineage 4 being predominant in the largest state in Southern Brazil. The study identified a high diversity of drug-resistant strains and highlighted the urgent need for controlling the transmission of multi-drug-resistant TB strains statewide.

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS (2021)