Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli Mycobacterium tuberculosis.
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Tuberculosis

Tuberculosis (commonly shortened to TB) is an infection caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (Miliary tuberculosis), genitourinary system, bones and joints. more...

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Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world's population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.

Most of those infected (90 percent) have asymptomatic latent TB infection (LTBI). There is a 10 percent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.

The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993.

Other names for the disease

  • TB (short for tuberculosis and also for Tubercle Bacillus)
  • Consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor, and long relentless wasting)
  • Wasting disease
  • White plague (TB sufferers appear markedly pale)
  • Phthisis (Greek for consumption) and phthisis pulmonalis
  • Scrofula (swollen neck glands)
  • King's evil (so called because it was believed that a king's touch would heal scrofula)
  • Pott's disease of the spine
  • Miliary TB (x-ray lesions look like millet seeds)
  • Tabes mesenterica (TB of the abdomen)
  • Lupus vulgaris (the common wolf - TB of the skin)
  • Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

The bacterium

The cause of tuberculosis, Mycobacterium tuberculosis (MTB), is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E. coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M. tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).

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Thoracic complications in tuberculosis and diabetes patients
From CHEST, 10/1/05 by Ma Cecilia Garcia-Sancho

PURPOSE: To determine the prevalence of thoracic complications among pulmonary tuberculosis and diabetes patients in comparison with patients with tuberculosis alone.

METHODS: This study was a cross-sectional survey based on the retrospective analysis of data of tuberculosis subjects in diabetic and not diabetic patients. The study was conducted at Clinic of Tuberculosis of National Institute of Respiratory Diseases (INER), Mexico.

RESULTS: One hundred and sixteen tuberculosis patients were included from july to December of 2003. Fifty-two cases of diabetes mellitus were identified among 116 tuberculosis patients, prevalence: 44.8%. Of 116 patients, 56 (48.3%) were males, with a ratio male:female of 0.93. Of 116 patients 91.4% have bacteriological confirmation. Of 116 patients (92/116) 79.3% have from 0 to 5 years from diagnosis of tuberculosis. The tuberculosis and diabetes patients were older than tuberculosis patients (mean [+ or -] SD 52.38 [+ or -] 11.35 versus 40.70 [+ or -] 16.55 p <.0001). Complications among diabetics or no diabetics patients were: bronchiectasis (96.2% versus 80.9%, p =.01); pneumonia (9.6% versus 1.6%, p=.05); pneumonia by Mycobacterium tuberculosis (7.7% versus 1.6%, p =.1) and hemoptysis (34.6% versus 29.7% p =.6). In multivariate analysis diabetes mellitus was associated to older age (OR= 1.06 years [CI95% 1.02-1.10] p <.0001) and to the presence of bronchiectasis (OR= 13.95 [CI95% 1.84-105] p =.01), controlling by crowding, pneumonia, empiema, hemoptysis and time since tuberculosis diagnosis.

CONCLUSION: The increased risk of bonchiectasies and pneumonia among patients with diabetes and tuberculosis suggest the difficulty of the host in the infection control. One of two tuberculosis patients was diabetics at INER.

CLINICAL IMPLICATIONS: It is necessary to do bacteriological and clinical surveillance for pulmonary tuberculosis among diabetic patients and clinical and metabolic surveillance for diabetes among tuberculosis patients with the purpose to prevent sequels and deaths due to tuberculosis.

DISCLOSURE: Ma Cecilia Garcia-Sancho, None.

Ma Cecilia Garcia-Sancho MS * Enrique L. Segundo MD Rafael V. Vazquez MS Alfredo Torres MD Manuel Castillejos MS Miguel Angel Salazar Lezama MD National Institute of Respiratory Diseases, Mexico, Mexico

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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