At a combination of Diabetes Mellitus (DM) and lung tuberculosis in overwhelming majority of cases (up to 90 %) DM is primary disease, on which background tuberculosis develops in various time periods. If both diseases come to light simultaneously, that, obviously, is latently proceeding DM has become aggravated under influence of joining tuberculosis. The uniform opinion is not present on the reason of accelerated tuberculosis morbidity among DM patients. No doubt that the tuberculosis develops in conditions reduced resistance of host to an infection, which is determined by an exhaustion of the patients at some forms of the diabetes. There is change of immunobiological properties, in particular by reduction of ability to develop antibodies and antitoxins of the DM patient. Development of the lung tuberculosis in such cases promotes not compensated or uncured DM.
Clinic signs of tuberculosis among the DM patients.
If tuberculosis is revealed in early stages then more favorably proceeding forms of disease are observed even in the combination with DM. The malignant, heavy current of tuberculosis predispose to fast progression and disintegration mainly at wrong treatment of DM or at late revealing of tuberculosis.
The first clinical signs of tuberculosis at DM are:
- increasing weakness;
- downturn of appetite;
- weight reduction;
- increase of symptoms of diabetes.
The disease can proceed at the beginning latently, therefore lung tuberculosis quite often is diagnosed at mass fluorographic or routine X-ray examinations.
Tuberculin tests are usually highly positive. However with development of the chronic forms of tuberculosis (fibrous-cavernous, hematogenicaly disseminated) – there comes an exhaustion of the host’s protective forces and the tuberculin sensitivity is reduced.
The process of tuberculosis in combination with DM differs by slower normalization of the disturbed metabolism, longer period of the tubercular intoxication and slow healing of cavities. The reasons of progression even of the small forms of tuberculosis (focus and small tuberculoma) is the underestimation of activity for the first time revealed tuberculosis, hence, untimely start therapy of tuberculosis, wrong diet and anti-diabetic treatment, that results in absence DM compensations.
The course of DM is aggravated on the background of joined tuberculosis. The level of sugar in blood raises, diuresis and glycosuria are increased, hyperacidity can appear. The worsening of metabolism is characterized by the prominent fluctuations of sugar content in blood within day, which causes in the patients sensation of dryness in the mouth, feeling of thirst, often urination. The fall in weight progresses. The given data have the large practical importance: any sudden deterioration of the DM current should cause the doctor’s suspicion on development of the tuberculosis. The features of tuberculosis course at the DM patients and adverse influence of tuberculosis on DM demand from the doctor to use skilful combination of all medical measures. In the past half of patients were lost from tuberculosis, joined DM. Clinical cure become possible of the tuberculosis and DM patients with introduction of physiological diet, insulin and chemotherapy in medical practice.
Increased tuberculosis incidence among the DM patients requires the special attention to tuberculosis prevention. The persons of young age, at which DM proceeds usually hardly and frequently is complicated by tuberculosis. This requires careful supervision and regular checks for tuberculosis.
Anti-diabetic therapy of the tuberculosis patients should be complex and individual, depending of host’s condition, form and phase of tubercular process and heaviness of DM.
Chemotherapy of the tuberculosis combined with DM should be carried out for a long time, continuously, in a combination of the various preparations, which have been individually chosen for particular patient.
Each DM patient, with whom tuberculosis for the first time is revealed, should be hospitalized.