Diabetes is Associated with Severe Adverse Events in Multidrug-Resistant Tuberculosis
Arch Bronconeumol. 2017 May;53(5):245-250.
doi: 10.1016/j.arbres.2016.10.021.
Epub 2017 Jan 11.
[Article in
English,
Spanish]
Authors
Marcela Muñoz-Torrico
1
, José Caminero-Luna
2
, Giovanni Battista Migliori
3
, Lia D'Ambrosio
4
, José Luis Carrillo-Alduenda
5
, Héctor Villareal-Velarde
1
, Alfredo Torres-Cruz
1
, Héctor Flores-Vergara
1
, Dina Martínez-Mendoza
1
, Cecilia García-Sancho
6
, Rosella Centis
7
, Miguel Ángel Salazar-Lezama
1
, Rogelio Pérez-Padilla
5
Affiliations
- 1 Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
- 2 Departamento de Neumología, Hospital Universitario de Gran Canaria «Dr. Negrín», Las Palmas, Canarias, España.
- 3 WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia. Electronic address: giovannibattista.migliori@fsm.it.
- 4 WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia; Public Health Consulting Group, Lugano, Suiza.
- 5 Clínica del Sueño, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
- 6 Departamento de Epidemiología, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
- 7 WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia.
Abstract
Introduction:
Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City.
Results:
Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9-21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8-54.2), but not for a worse outcome.
Conclusions:
Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.
Keywords:
Adverse events; Diabetes mellitus; Mexico; Multidrug-resistant tuberculosis; México; Reacciones adversas; Tuberculosis; Tuberculosis multirresistente.
Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.
MeSH terms
-
Adult
-
Antitubercular Agents / adverse effects*
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Catheter-Related Infections / epidemiology
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Catheter-Related Infections / etiology
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Comorbidity
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Diabetes Mellitus, Type 2 / complications*
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Disease Susceptibility
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Extensively Drug-Resistant Tuberculosis / drug therapy
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Extensively Drug-Resistant Tuberculosis / epidemiology
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Female
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HIV Infections / epidemiology
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Hearing Loss / chemically induced
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Hearing Loss / epidemiology
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Humans
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Hypertension / epidemiology
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Hypothyroidism / chemically induced
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Hypothyroidism / epidemiology
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Kidney Diseases / chemically induced
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Kidney Diseases / epidemiology
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Male
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Mexico / epidemiology
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Middle Aged
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Nausea / chemically induced
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Nausea / epidemiology
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Retrospective Studies
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Treatment Outcome
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Tuberculosis, Multidrug-Resistant / drug therapy*
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Tuberculosis, Multidrug-Resistant / epidemiology
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Tuberculosis, Pulmonary / drug therapy*
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Tuberculosis, Pulmonary / epidemiology
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Young Adult