[Pulmonary tuberculosis and diabetes: aspects of its epidemiology, pathophysiology, and symptoms]

Pulmonary tuberculosis in patients with diabetes is characterized by its severity, which some physicians consider to require surgery. Many pathophysiologic explanations have been proposed for this particular disease association, in which cellular immunity is depressed with fewer T lymphocytes in the blood and a diminished capacity for blast transformation. Although the lungs are not generally considered a target organ of diabetes, the English-language literature appears to demonstrate the contrary. Non-enzymatic glycosylation and autonomic neuropathy are involved in these phenomena, which make diabetic patients more susceptible to infection, especially tuberculosis. Some authors nonetheless consider symptoms of this combination unremarkable. Thus multiple tubercular sites on the lungs are the principal observation in tuberculosis patients with and without diabetes. Prognosis is worse when associated with bacterial excretion and thus tuberculosis mortality. Patients with diabetes are more sensitive to this type of infection because of their depressed cellular immunity and cytokine production, related to harmful effect of non-enzymatic glycosylation. These factors suggest the particularity of the epidemiology, pathophysiology and symptoms of diabetes associated with tuberculosis.