Prevalence and clinical features of tuberculosis in Ethiopian diabetic patients.

OBJECTIVE To determine the prevalence and clinical characteristics of tuberculosis (TB) in diabetic patients. DESIGN This study was a cross-sectional survey based on the retrospective analysis of data on tuberculosis in diabetic patients. SETTINGS The study was conducted at Endocrinology and Metabolism Unit of the Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia. SUBJECTS Seventy-eight cases of tuberculosis among 1352 diabetic patients were included from September 1989 to 1996. MAIN OUTCOME MEASURES Clinical evaluation, chest x-ray, acid fast bacilli (AFB) in sputum or measures tissue and histopathologic characteristic of biopsy specimens. RESULTS Seventy-eight cases of TB were identified among 1352 diabetic patients giving a prevalence of 5.8%. Among 1352 diabetic patients, 713 (52.7%) were males, 639 (43.3%) were females, 619 (45.8%) were IDDM and 733 (54.2%) were NIDDM. The mean age of the 71 TB patients whose records could be retrieved was 34.0 +/- 11.9 years, 42(59%) were males, 29 (41%) were females. Fifty-four (76.1%) were IDDM and 17(23.9%) were NIDDM, 17 of the IDDM had clinical characteristics of malnutrition-related diabetes mellitus (MRDM), 36 (56%) of 71 patients were admitted for management. The three most common symptoms of tuberculosis were fever (80.5%), sweating (80.4%) and cough (70.5%). Twenty six (36.6%) of 71 cases were positive for AFB and six (8.5%) were seropositive for HIV. Fifty-six (78.9%) had pulmonary,eight (11.2%) had extrapulmonary and seven(9.8%) had disseminated TB. Forty-eight of 53 abnormal chest x-ray showed unilateral involvement. Thirty-eight of 41 (53.6%) had completed TB treatment, relapse occurred in seven (9.8%), eight (11.2%) are currently on treatment, 13 (18.3%) were lost to follow up, four (5.6%) defaulted and three (4.2%) died. The relative risk of developing TB in IDDM and NIDDM patients was being 26 times and seven times than the general population respectively. CONCLUSION The prevalence of tuberculosis in the diabetic population is high and this warrants a prospective study to determine association between pulmonary tuberculosis and diabetes.