title: Tuberculosis: a resurgent disease in immunosuppressed patients.
abstract: A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9%) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3%) and miliary TB (14; 21%) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6%) and lymphadenopathy (17; 25.4%) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3%) and TB/DM (20; 29%) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8%) than TB/HIV (13; 19.4%) (p<0.05). A success rate of 15 (21.7%) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4%) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients.
authors.affiliation: Department of Parasitology, University of Malaya Medical Center, Kuala Lumpur, Malaysia. nissapat@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Nissapatorn
authors.forename: I
authors.initials: I
authors.lastname: Kuppusamy
authors.forename: F P
authors.initials: FP
authors.lastname: Josephine
authors.forename: I
authors.initials: I
authors.lastname: Jamaiah
authors.forename: M
authors.initials: M
authors.lastname: Rohela
authors.forename: A
authors.initials: A
authors.lastname: Khairul Anuar
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000276:immunology*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000276:immunology*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000276:immunology*