RESUMO
Given the well-known linkage between diabetes mellitus (DM) and tuberculosis (TB), the World Health Organization recommends bidirectional screening. Here we report the first screening effort of its kind from a chest clinic in the Ampara district of Sri Lanka. Of 112 TB patients registered between January 2013 and October 2014, eight had pre-existing DM. Of those remaining, 83 (80%) underwent fasting plasma glucose testing, of whom two (2%) and 17 (20%) were found to have diabetes and impaired fasting glucose, respectively. All of these were enrolled in care. Screening TB patients for DM was found to be feasible at the district level. Further studies at the provincial/country level are required before making any decision to scale up bidirectional screening.
Etant donné le lien bien connu entre diabète (DM) et tuberculose (TB), l'Organisation Mondiale de la Santé recommande un dépistage bidirectionnel. Nous rapportons ici le premier effort de dépistage de ce type au Sri Lanka dans un centre de maladies respiratoires du district d'Ampara. Sur 112 patients TB enregistrés entre janvier 2013 et octobre 2014, huit avaient un DM préexistant. Parmi les autres, 83 (80%) ont eu une glycémie à jeun et parmi eux, respectivement deux (2%) et 17 (20%) ont eu un diabète et une glycémie à jeun trop élevée; tous ont été enrôlés dans un programme de soins. Le dépistage du DM chez des patients TB s'est avéré faisable au niveau du district. D'autres études au niveau provincial/national sont nécessaires avant de décider l'extension de la stratégie.
Dado el vínculo reconocido entre la diabetes (DM) y la tuberculosis (TB), la Organización Mundial de la Salud recomienda la detección sistemática bidireccional. En el presente estudio se comunica la primera campaña de detección de este tipo emprendida en Sri Lanka, en un consultorio de neumología del distrito de Ampara. De los 112 pacientes notificados al registro de TB de enero del 2013 a octubre del 2014, en ocho prexistía el diagnóstico de DM. De los casos restantes (80%), en 83 se practicó la glucemia plasmática en ayunas y se puso en evidencia el diagnóstico de DM en dos de ellos (2%) y 17 pacientes presentaron una glucemia basal alterada (20%); todos los pacientes ingresaron a un programa de atención. Se confirmó que es factible practicar la detección sistemática de la DM en los pacientes con diagnóstico de TB a escala distrital. Será necesario realizar estudios a escala de la provincia y del país antes de adoptar decisiones de ampliación de escala de la medida.
RESUMO
SETTING: Five districts in Sri Lanka. OBJECTIVES: To determine: 1) the proportion of sputum smear-positive pulmonary tuberculosis (PTB) cases who failed to smear convert at 2 months, 2) their management, and 3) whether baseline characteristics and final treatment outcomes were different from those who did smear convert. DESIGN: Cross-sectional retrospective review of medical files, tuberculosis (TB) registers and TB treatment records of new smear-positive PTB patients registered from January to December 2010. RESULTS: Of 925 patients, 840 were available to submit sputum at 2 months, of whom 137 (16%) were smear-positive. Baseline sputum smears showing 3+ acid-fast bacilli and missing doses of anti-tuberculosis drugs during the initial phase of treatment were significantly associated with being smear-positive at 2 months. Management was poor: of 137 patients, 46 (34%) submitted sputum for culture and drug susceptibility testing and Mycobacterium tuberculosis was cultured in six cases; 120 (88%) received a 1-month extension of the initial phase, and of the 30 patients still smear-positive at 3 months there were no culture results available. Final treatment outcomes were similar, regardless of smear conversion at 2 or 3 months. CONCLUSION: Certain characteristics were risk factors for failure to smear convert at 2 months. However, treatment outcomes for all patients were good. These findings have implications for the modification of national programme recommendations.