Diabetes screening among active tuberculosis patients in Western Australia Tuberculosis Control Program using HbA1c.

BACKGROUND: Diabetes mellitus is an important risk factor for tuberculosis (TB), and studies in high TB burden countries have shown diabetes screening to be both feasible and to have a high yield. However, scarce information is available for low TB burden countries. Diabetes screening was previously not part of our routine practice. AIM: To screen and determine the prevalence of diabetes in the Western Australian Tuberculosis Control Program. METHODS: We measured HbA1c and random plasma glucose in patients with active TB. We also collected details on their demographics, TB and diabetes. RESULTS: A total of 105 patients was recruited over a year. Of those, 17 (16.2%) had diabetes. Seven cases (6.7%) were newly diagnosed diabetics. Age, cavitating disease and family history of diabetes were found to be significantly associated with diabetes. Multilobar disease, gender, body mass index, smear and culture positivity were not significantly different between groups. CONCLUSION: Our study showed high prevalence of diabetes among active TB patients. Diabetes screening at diagnosis of active TB presents as a good opportunity to detect diabetes even in low prevalence country and has become part of our standard care.

A rare case of lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum.

With over 150 species, non-tuberculous mycobacteria are increasingly recognized to be important human pathogens that pose diagnostic and management challenges. We report a rare case of cervical lymphadenitis and pulmonary disease caused by Mycobacterium paraffinicum in a 64-year-old man who presented with three-month history of increasing right-sided painless neck lump. His medical history included rheumatoid arthritis, which was managed with leflunomide and methotrexate. Computed tomography scans of his neck and thorax revealed a right lower neck and supraclavicular fossa cystic mass with peripheral enhancement and bilateral multiple small pulmonary nodules. M. paraffinicum was cultured from a fine-needle aspiration of the mass. Two out of three sputa were acid-fast bacilli smear positive but cultures did not yield any viable organism. He developed spontaneous discharge of purulent material via a sinus, which drained over two months and recovered with a completely healed sinus without any further treatment.