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The chemotherapy for pulmonary tuberculosis complicated with diabetes mellitus






Kekkaku 61(8): 413-424

The chemotherapy for pulmonary tuberculosis complicated with diabetes mellitus

Impaired cell-mediated immune responses have been reported in diabetes mellitus. The present study was aimed to clarify the influence of the complicated diabetes mellitus on the optimal length of chemotherapy for pulmonary tuberculosis. We studied inpatients in our hospital during the six year period from 1977 to 1983 including 203 cases of newly diagnosed tuberculosis complicated with diabetes mellitus and 185 cases without diabetes mellitus. Forty-five retreated cases of tuberculosis complicated with diabetes mellitus and 91 cases without diabetes mellitus were also included in the study. In newly diagnosed tuberculosis in which bacilli were sensitive to drugs, ordinary chemotherapy with INH and RFP gave an excellent result on the disease whether complicated with diabetes mellitus or not; in nearly all cases studied, acid-fast bacilli in sputa were converted to negative within 4 months after the initiation of chemotherapy. Five year follow-up study revealed only 3 cases of relapse out of 146 cases (2.1%) of diabetes mellitus-complicated tuberculosis which received the ordinary chemotherapy of less than 12 months, at most 18 months. This relapse rate of 2.1% is comparable to that in non-complicated tuberculosis (2 in 133 cases, 1.5%) during the 3 year follow-up period. In retreatment study of tuberculosis, the effect of chemotherapy was dependent on the susceptibility of drugs to bacilli at the initiation of retreatment. The result of 9 .apprx. 12 months-chemotherapy was favorable in cases of tuberculosis which were sensitive to INH and RFP regardless of complication with diabetes mellitus or not. In cases of tuberculosis which were resistant to these drugs, no clinical as well as bacteriological improvement was achieved even after prolonged chemotherapy. The above data indicate that coexisting diabetes mellitus in pulmonary tuberculosis gives little unfavorable effect on the treatment of tuberculosis. We conclude that the success in treatment of pulmonary tuberculosis depends on whether the bacilli are sensitive to the drugs or not and not on whether complicated with diabetes mellitus or not. In drug-sensitive cases, one year chemotherapy is enough for the treatment of diabetes mellitus-complicated tuberculosis whether it is has been treated before or not.

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Accession: 006614101



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