Rifampin resistance and diabetes mellitus in a cross-sectional study of adult patients in rural South India.
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.
Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY, 14853, USA. smehta@cornell.edu.|Arogyavaram Medical Centre, Andhra Pradesh, India. smehta@cornell.edu.|Division of Infectious Diseases, St. John's Research Institute, Bangalore, Karnataka, India. smehta@cornell.edu.
Saurabh
S
Mehta
Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY, 14853, USA. eay27@cornell.edu.
Elaine Ann
EA
Yu
Division of Infectious Diseases, St. John's Research Institute, Bangalore, Karnataka, India. mail2fazil@gmail.com.
Syed Fazil
SF
Ahamed
Arogyavaram Medical Centre, Andhra Pradesh, India. wesleywesleyamc@yahoo.co.in.
Wesley
W
Bonam
Arogyavaram Medical Centre, Andhra Pradesh, India. johnkennet@gmail.com.|Division of Infectious Diseases, St. John's Research Institute, Bangalore, Karnataka, India. johnkennet@gmail.com.
John
J
Kenneth
D000328:Adult; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000382:microbiology*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012293:Rifampin / Q000494:pharmacology*; D012424:Rural Population; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
D012293:Rifampin