ROLE OF DIABETES IN ATYPICAL RADIOLOGICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Abstract

Background; Diabetes mellitus has been reported to modify the presenting features of pulmonary tuberculosis, but there are varying data, particularly regarding the association with lower lung field involvement. This study was conducted to document frequency of atypical radiological presentation of pulmonary tuberculosis in our population of Southern Punjab. Material and methods; A total of 200 study cases having age range; 35 – 70 years of either sex having diabetes for more than 1 year and pulmonary tuberculosis (irrespective of disease duration) were included in our study. Known cases having Malignancies, HIV, pregnant ladies, asthmatic patients and those with COPD were excluded from our study. Patients of pulmonary tuberculosis fulfilling the inclusion and exclusion criteria was included in this study. Sociodemographic and Radiological data from each was collected and recorded on a performa. Results; Of these 200 study cases, 116 (58%) were male patients while 84 (42%) were female patients. Mean age of our study cases was noted to be 55.52 ± 9.33 years (with minimum age was 38 years while maximum age was 70 years). Of these 200 study cases, 117 (58.5%) were from rural areas and 117 (58.5 %) were poor. Mean duration of diabetes in these patients was 7.41 ± 3.76 years (with minimum duration of diabetes was 3 years while maximum duration was noted to 15 years). Mean duration of tuberculosis was 6.74 ± 2.29 months (with minimum duration of disease was 2 months and maximum duration was 12 months).

Diabetes was controlled in only 33 (16.5%) of our study cases and only 63 (31.5%) were taking treatment for diabetes. Right side of lungs affected was seen in 105 (52.5%) and lower lung field was affected in 116 (58 %) of our study cases. Atypical presentation was seen in 95 (47.5%) of our study cases.

Conclusion; Frequency of atypical radiological presentation of pulmonary tuberculosis was high in our study. Atypical presentation of pulmonary tuberculosis in patients with diabetes is quite common. Atypical presentation was significantly associated with gender, age groups, residential status, socioeconomic status, duration of diabetes, control of diabetes, treatment status of diabetes, lung side affected and lung field affected. Clinicians treating diabetic patients must keep these facts in their minds while treating such patients to avoid miss-diagnosis.

Keywords; Diabetes, tuberculosis, atypical presentation.