Diabetes mellitus is strongly associated with tuberculosis in Indonesia.

SETTING: Diabetes mellitus is a known risk factor for tuberculosis (TB), but no studies have been reported from South-East Asia, which has a high burden of TB and a rapidly growing prevalence of diabetes. OBJECTIVE: To examine if and to what extent diabetes is associated with an increased risk of TB in an urban setting in Indonesia. DESIGN: Case-control study comparing the prevalence of diabetes mellitus (fasting blood glucose level >126 mg/dl) among newly diagnosed pulmonary TB patients and matched neighbourhood controls. RESULTS: Patients and control subjects had a similar age (median 30 years) and sex distribution (52% male), but malnutrition was more common among TB patients (median body mass index 17.7 vs. 21.5 kg/m2). HIV infection was uncommon (1.5% of patients). Diabetes mellitus was present in 60 of 454 TB patients (13.2%) and 18 of 556 (3.2%) control subjects (OR 4.7; 95%CI 2.7-8.1). Adjustment for possible confounding factors did not reduce the risk estimates. Following anti-tuberculosis treatment, hyperglycaemia reverted in a minority (3.7%) of TB patients. CONCLUSION: Diabetes mellitus is strongly associated with TB in young and non-obese subjects in an urban setting in Indonesia. This may have implications for TB control and patient care in this region.

Better patient instruction for sputum sampling can improve microscopic tuberculosis diagnosis.

To examine the effect of patient instruction for provision of sputum samples, we performed a randomised controlled trial involving 174 patients with suspected tuberculosis (TB) in an urban TB clinic in Indonesia. TB was diagnosed in 50.6% of patients who received additional counselling by paramedics compared with 35.5% of patients in the control group following routine diagnostic procedure, corresponding to a 15.1% higher detection rate (95%CI 2.9-27.4). Significant differences were also found for sputum volume, consistency, positivity rate and density of acid-fast bacilli. Simple interventions such as these may increase TB case detection in Indonesia and elsewhere.

Low plasma concentrations of rifampicin in tuberculosis patients in Indonesia.

SETTING: Although rifampicin is a key drug in tuberculosis treatment, little is known about its quality and bioavailability in countries endemic for tuberculosis. High drug levels may lead to increased toxicity, while low drug levels may predispose to treatment failure and relapse. OBJECTIVE: To investigate possible variations in the bioavailability of plasma rifampicin in tuberculosis patients in Indonesia. DESIGN: Plasma concentrations of rifampicin and the rifampicin content of drug formulations in use were measured among 62 non-selected tuberculosis patients in Jakarta, Indonesia. RESULTS: Plasma concentrations of rifampin were generally low: 70% of patients had 2-hour plasma concentrations (Cmax) below 4 mg/L. No toxic plasma concentrations of rifampicin (>20 mg/L) were found. The strongest predictive factor for the magnitude of rifampicin concentrations was the drug manufacturer. The rifampicin content of the different drug preparations used was normal (90.5-103.6% of the reference standard). No association was found between low plasma rifampicin concentrations and delayed sputum conversion or treatment failure. CONCLUSION: The unexpectedly low plasma concentrations of rifampicin in this setting are most likely due to reduced bioavailability of local drug preparations, as the rifampicin content of the drug preparations was found to be normal. The clinical significance of these findings remains to be determined.

[Comparative study of two dried intradermal BCG vaccines (author's transl)]. / Etude comparative de deux vaccins BCG secs intradermiques.

Two BCG vaccines prepared from the same strain were studied clinically in Indonesia and in France. The concentration in culturable particles was comparable. Observed differences in the Mantoux results are discussed. The French results, based on use in a temperate climate by a specialized team, on well nourished children, appear better than the Indonesian findings. Further steps should be undertaken to improve results in Indonesia.

Tuberculosis in Indonesia: recent studies on detection and drug susceptibility of mycobacteria in Jakarta.

Sputum specimens from more than 1000 Indonesian tuberculosis suspects were examined by bacteriologic culture, and by bright field and fluorescence microscopy. Two hundred twenty had positive Mycobacterium tuberculosis cultures and of these 68% were positive by fluorescence microscopy. Agreement between culture, both negative and positive, and fluorescence microscopy was 87%. Sensitivity to antituberculous drugs was performed in 209 isolates. Significant resistance to isoniazid, para-amino salicylic acid, and streptomycin was found i.e. 65 (31%), 19 (19%), 54 (26%), respectively. Fluorescence microscopy was a useful method for rapid microscopic confirmation of tuberculosis and was especially valuable in detecting difficult-to-culture organisms.