RESUMO
Introduction: To assess the status of bi-directional screening for COVID-19, tuberculosis and diabetes among people attending Non-communicable Disease (NCD), Directly Observed Treatment Short-course (DOTS), and flu clinics of a secondary care hospital in rural northern India. Material and Methods: A cross?sectional, analytical study was conducted among the eligible (aged ?18 years) population who attended the study clinics in a rural sub-district hospital. In the flu clinic, consecutive patients were assessed for screening for TB (symptom-based) and diabetes (random blood sugar) and status of referral to DOTS and NCD clinics. Similarly, the screening for diabetes and COVID-19, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) in the DOTS clinic, and TB and COVID-19 in the NCD clinic were assessed. The independent association of factors with COVID-19 positivity were assessed by calculating the adjusted prevalence ratios (aPR) at 95% confidence interval (CI). Results: Of the 405 people assessed, 279 (68.9%), 102 (25.2%), and 24 (5.9%) were from flu, NCD, and DOTS clinics, respectively. 26 (25.5%) and 22 (91.7%) of NCD and DOTS clinic patients underwent RT-PCR for COVID-19. TB screening in NCD and flu clinics was done among 4 (3.9%) and 7 (12.5%), respectively. A total of 23 (9.0%) were found positive for COVID-19, and no factors other than the presence of COVID-19 symptoms (aPR: 2.89; 95% CI: 1.33–6.29) had any independent association with COVID-19 positive status. Conclusion: The low screening for TB in NCD and flu clinics indicates the need to strengthen the implementation the TB-DM and TB-COVID-19 bidirectional screening. Similarly, the low screening or testing for COVID-19 in the NCD clinic can be improved by the implementation of systematic screening strategies like TB-DM bidirectional screening.
RESUMO
ABSTRACT There is an increased burden of diabetes mellitus (DM) in resource poor setting, coupled with the susceptibility to co-infection with tuberculosis (TB) especially in a high endemic TB area. Programmatic re-engineering of screening for TB amongst patients with DM is needed to ensure a control of an ongoing silent coepidemic of DM and TB. We report two cases highlighting the importance of screening for TB among patients living with DM. Each case had a peculiar characteristic highlighting the role of TB screening and poor outcomes of TB in patients with DM. Case 1 is a 32-year-old nurse with uncontrolled DM, glycated haemoglobin of 16.1% on maximum dose of oral hypoglycaemic agents, who presented with night sweat, fever, weight loss, and left-sided chest pain of 2-week duration. She had a negative sputum GeneXpert for acid fast bacilli (AFB), and a chest radiograph was suggestive of left-sided pleura effusion which responded to TB treatment. Case 2 is a 45-year-old female with uncontrolled DM, who had associated complication of DM. She was diagnosed as pulmonary TB by sputum GeneXpert sensitive to rifampicin; however, by the 5th to 6th month of therapy, she presented with recurrent cough, fever and night sweat. Sputum AFB GeneXpert was positive for AFB but resistant to rifampicin. Undertaking TB screening among patients with DM in clinical practice needs to be intensified in order to improve the outcomes of both TB and control the epidemics.