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BMC Infectious Diseases

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Open Access 01-12-2016 | Review

Convergence of a diabetes mellitus, protein energy malnutrition, and TB epidemic: the neglected elderly population

Authors: Sonia Menon, Rodolfo Rossi, Leon Nshimyumukiza, Aibibula Wusiman, Natasha Zdraveska, Manal Shams Eldin

Published in: BMC Infectious Diseases | Issue 1/2016

Abstract

Background

On a global scale, nearly two billion persons are infected with Mycobacterium tuberculosis. From this vast reservoir of latent tuberculosis (TB) infection, a substantial number will develop active TB during their lifetime, with some being able to transmit TB or Multi-drug- resistant (MDR) TB to others. There is clinical evidence pointing to a higher prevalence of infectious diseases including TB among individuals with Diabetes Mellitus (DM). Furthermore, ageing and diabetes mellitus may further aggravate protein-energy malnutrition (PEM), which in turn impairs T-lymphocyte mediated immunologic defenses, thereby increasing the risk of developing active TB and compromising TB treatment. This article aims to a) highlight synergistic mechanisms associated with immunosenescence, DM and PEM in relation to the development of active TB and b) identify nutritional, clinical and epidemiological research gaps.

Methods

To explore the synergistic relationship between ageing, DM, tuberculosis and PEM, a comprehensive review was undertaken. The MEDLINE and the Google Scholar databases were searched for articles published from 1990 to March 2015, using different MESH keywords in various combinations.

Results

Ageing and DM act synergistically to reduce levels of interferon gamma (IFN- γ), thereby increasing susceptibility to TB, for which cell mediated immunity (CMI) plays an instrumental role. These processes can set in motion a vicious nutritional cycle which can predispose to PEM, further impairing the CMI and consequently limiting host defenses. This ultimately transforms the latent TB infection into active disease. A clinical diagnostic algorithm and clinical guidelines need to be established for this population.

Conclusion

Given the increase in ageing population with DM and PEM, especially in resource-poor settings, these synergistic tripartite interactions must be examined if a burgeoning TB epidemic is to be averted. Implementation of a comprehensive, all-encompassing approach to curb transmission is clearly indicated. To this end, clinical, nutritional and epidemiological research gaps must be addressed without a delay.

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Title: Convergence of a diabetes mellitus, protein energy malnutrition, and TB epidemic: the neglected elderly population
Authors: Sonia Menon
Rodolfo Rossi
Leon Nshimyumukiza
Aibibula Wusiman
Natasha Zdraveska
Manal Shams Eldin
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-016-1718-5

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Convergence of a diabetes mellitus, protein energy malnutrition, and TB epidemic: the neglected elderly population

Abstract

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Conclusion

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