Tuberculosis in Pakistan

  • Smoking is recognized as a significant risk factor for tuberculosis and a major public health concern in Pakistan. Surprisingly, this study did not find a statistical association between tuberculosis and diabetes comorbidity.
  • Diabetic patients face a substantial risk of developing tuberculosis compared to non-diabetic individuals.
  • The rising prevalence of diabetes mellitus (DM) poses a potential threat to tuberculosis control measures, particularly in middle- and low-income countries.

    Khalid N, Ahmad F, Qureshi FM. Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pak J Med Sci. 2021;37(3):816-820.

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    Another study:

    Meghji, J., Kon, O.M. and Ainley, A., 2023. Clinical tuberculosis. Medicine, 51(11), pp.768-773.

    Thirty high-TB-burden countries account for 87% of global cases, with incident rates exceeding 150/100,000. Two-thirds of these cases occur in just eight countries: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of the Congo. England has been classified as a low-incidence area (<10/100,000) since 2017, with a rate of 7.3/100,000 in 2021. In 2020, England reported 4,125 TB cases, but national data obscure significant disparities, particularly among those born outside the UK, who accounted for 72.8% of cases (36.3/100,000).

    See also: TB and dialysis

    In 2020, 12.7% of TB patients had at least one social risk factor (alcohol or drug misuse, homelessness, imprisonment). Latent TB infection (LTBI) occurs when there is no clinical evidence of active disease despite a persistent immune response to TB antigens, with a 5-10% risk of progressing to active TB, typically within five years.

    See also: Lin TB Lab

    In 2020, 48.6% of TB cases in England were pulmonary. Symptoms of pulmonary TB (PTB) include cough, fever, night sweats, and weight loss, though haemoptysis is not always present. The WHO’s ‘End TB’ strategy promotes new diagnostic tools like Xpert MTB/RIF, a rapid assay detecting M. tuberculosis, despite its lower sensitivity in smear-negative or extrapulmonary cases. The Xpert MTB/RIF Ultra, recommended by WHO in 2017, has improved sensitivity, especially for CNS disease and HIV-positive patients.

    See also: TB and Diabetes mellitus

    The FluoroType MTBDR assay and the developing FluoroType XDR-TB offer advanced resistance profiling. Point-of-care strategies, such as urinary lipoarabinomannan detection, aim to decentralize TB diagnostics, particularly in low-resource settings. Cepheid's GeneXpert platforms are under review by WHO for use in these areas.

    See also: TB Predictive Modelling

    MDR/RR-TB patients are recommended all-oral regimens, avoiding injectables. NICE advises LTBI treatment in patients under 65 with close contact history to drug-sensitive pulmonary/laryngeal TB, with caution for those aged 35-65 due to hepatotoxicity risks. LTBI treatment typically involves rifampicin and isoniazid or monotherapy options, with newer WHO-endorsed regimens like weekly rifapentine. However, rifapentine access in Western Europe remains limited due to licensing issues. 

    (Editor: Yoseph Leonardo Samodra)

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