Rifampin resistance and diabetes mellitus in a cross-sectional study of adult patients in rural South India

BMC Infectious Diseases

John Kenneth³  Wesley Bonam¹  Syed Fazil Ahamed³  Elaine Ann Yu²  Saurabh Mehta³ 

[1] Arogyavaram Medical Centre, Andhra Pradesh, India;Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca 14853, NY, USA;Division of Infectious Diseases, St. John’s Research Institute, Bangalore, Karnataka, India

关键词: South Asia;    Diagnostics;    India;    Diabetes;    Rifampin;    Drug resistance;    Tuberculosis;   

Others  :  1232848
DOI  :  10.1186/s12879-015-1204-5

 received in 2015-04-26, accepted in 2015-10-12,  发布年份 2015

【 摘 要 】

Background

Despite increasing reports of the linkage between diabetes and tuberculosis (TB), there is limited information regarding diabetes and TB drug resistance.

Methods

In this cross-sectional study, sputum and blood samples were collected from 304 adult patients in rural Andhra Pradesh. Rifampin resistance was assessed by Xpert MTB/RIF (Xpert), and diabetes status was based on self-report. Additionally, samples were assayed by acid-fast bacilli sputum smear microscopy (AFB) and QuantiFERON-TB Gold In-Tube (QFT-G), in order to compare relative diagnostic performances.

Results

Among patients with confirmed TB (n = 194), diabetes was associated with 3.0-fold higher risk of rifampin resistance (95 % CI 1.3–6.7). Considering Xpert MTB/RIF the gold standard, AFB had lower sensitivity (72.2 vs. 82.5 %) and higher specificity (96.4 vs. 37.0 %) compared to QFT-G for diagnosing TB.

Conclusions

The increased risk of rifampin resistance in patients with diabetes highlights the need for integrated diabetes surveillance in TB programs, particularly in settings undergoing the epidemiological transition.

【 授权许可】

   
2015 Mehta et al.

【 参考文献 】

• [1]Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009; 9(12):737-46.
• [2]Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, Ottmani S-E, Goonesekera SD, Murray MB. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011; 9(1):81. BioMed Central Full Text
• [3]Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008; 5(7):e152.
• [4]Global Tuberculosis Report 2014. World Health Organization, Geneva; 2014.
• [5]Nijland HM, Ruslami R, Stalenhoef JE, Nelwan EJ, Alisjahbana B, Nelwan RH, van der Ven AJ, Danusantoso H, Aarnoutse RE, van Crevel R. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis. 2006; 43(7):848-54.
• [6]Weiner M, Benator D, Burman W, Peloquin CA, Khan A, Vernon A, Jones B, Silva-Trigo C, Zhao Z, Hodge T. Association between acquired rifamycin resistance and the pharmacokinetics of rifabutin and isoniazid among patients with HIV and tuberculosis. Clin Infect Dis. 2005; 40(10):1481-91.
• [7]Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Q. 2005; 83(4):731-57.
• [8]Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest J. 2001; 120(5):1514-9.
• [9]Perez-Navarro LM, Fuentes-Dominguez FJ, Zenteno-Cuevas R. Type 2 diabetes mellitus and its influence in the development of multidrug resistance tuberculosis in patients from southeastern Mexico. J Diabetes Complications. 2014; 29(1):77-82.
• [10]Chang JT, Dou HY, Yen CL, Wu YH, Huang RM, Lin HJ, Su IJ, Shieh CC. Effect of type 2 diabetes mellitus on the clinical severity and treatment outcome in patients with pulmonary tuberculosis: a potential role in the emergence of multidrug-resistance. J Formos Med Assoc. 2011; 110(6):372-81.
• [11]Babalik A, Ulus IH, Bakirci N, Kuyucu T, Arpag H, Dagyildizi L, Capaner E. Plasma concentrations of isoniazid and rifampin are decreased in adult pulmonary tuberculosis patients with diabetes mellitus. Antimicrob Agents Chemother. 2013; 57(11):5740-2.
• [12]Magee MJ, Kempker RR, Kipiani M, Tukvadze N, Howards PP, Narayan KM, Blumberg HM. 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. 2014; 9(4):e94890.
• [13]Zignol M, Gemert WV, Falzon D, Sismanidis C, Glaziou P, Floyd K, Raviglione M. Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007–2010. Bull World Health Organ. 2012; 90(2):111-9.
• [14]Almeida D, Rodrigues C, Udwadia ZF, Lalvani A, Gothi GD, Mehta P, Mehta A. Incidence of multidrug-resistant tuberculosis in urban and rural India and implications for prevention. Clin Infect Dis. 2003; 36(12):e152-4.
• [15]Sester M, Sotgiu G, Lange C, Giehl C, Girardi E, Migliori GB, Bossink A, Dheda K, Diel R, Dominguez J et al.. Interferon-gamma release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2011; 37(1):100-11.
• [16]Margolis KL, Lihong Q, Brzyski R, Bonds DE, Howard BV, Kempainen S, Simin L, Robinson JG, Safford MM, Tinker LT et al.. Validity of diabetes self-reports in the Women’s Health Initiative: comparison with medication inventories and fasting glucose measurements. Clin Trials. 2008; 5(3):240-7.
• [17]Boehme CC, Nicol MP, Nabeta P, Michael JS, Gotuzzo E, Tahirli R, Gler MT, Blakemore R, Worodria W, Gray C et al.. Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet. 2011; 377(9776):1495-505.
• [18]Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, Vogt M, Bekker L-G, Wood R. Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med. 2011; 8(7):e1001067.