Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis.
<h4>Introduction</h4>Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing...
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2017-01-01
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| author | Francles Blanco-Guillot Guadalupe Delgado-Sánchez Norma Mongua-Rodríguez Pablo Cruz-Hervert Leticia Ferreyra-Reyes Elizabeth Ferreira-Guerrero Mercedes Yanes-Lane Rogelio Montero-Campos Miriam Bobadilla-Del-Valle Pedro Torres-González Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes Garcia-Garcia |
| author_facet | Francles Blanco-Guillot Guadalupe Delgado-Sánchez Norma Mongua-Rodríguez Pablo Cruz-Hervert Leticia Ferreyra-Reyes Elizabeth Ferreira-Guerrero Mercedes Yanes-Lane Rogelio Montero-Campos Miriam Bobadilla-Del-Valle Pedro Torres-González Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes Garcia-Garcia |
| author_sort | Francles Blanco-Guillot |
| collection | DOAJ |
| description | <h4>Introduction</h4>Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus.<h4>Materials and methods</h4>We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words "tuberculosis AND transmission" OR "tuberculosis diabetes mellitus" OR "Mycobacterium tuberculosis molecular epidemiology" OR "RFLP-IS6110" OR "Spoligotyping" OR "MIRU-VNTR". Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used.<h4>Results</h4>Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40-1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429).<h4>Conclusion</h4>There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts. |
| format | Article |
| id | doaj-art-b804bf0e4cc842aabc6bb502cd7be2da |
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| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-b804bf0e4cc842aabc6bb502cd7be2da2025-08-20T03:24:02ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018467510.1371/journal.pone.0184675Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis.Francles Blanco-GuillotGuadalupe Delgado-SánchezNorma Mongua-RodríguezPablo Cruz-HervertLeticia Ferreyra-ReyesElizabeth Ferreira-GuerreroMercedes Yanes-LaneRogelio Montero-CamposMiriam Bobadilla-Del-VallePedro Torres-GonzálezAlfredo Ponce-de-LeónJosé Sifuentes-OsornioLourdes Garcia-Garcia<h4>Introduction</h4>Many studies have explored the relationship between diabetes mellitus (DM) and tuberculosis (TB) demonstrating increased risk of TB among patients with DM and poor prognosis of patients suffering from the association of DM/TB. Owing to a paucity of studies addressing this question, it remains unclear whether patients with DM and TB are more likely than TB patients without DM to be grouped into molecular clusters defined according to the genotype of the infecting Mycobacterium tuberculosis bacillus. That is, whether there is convincing molecular epidemiological evidence for TB transmission among DM patients. Objective: We performed a systematic review and meta-analysis to quantitatively evaluate the propensity for patients with DM and pulmonary TB (PTB) to cluster according to the genotype of the infecting M. tuberculosis bacillus.<h4>Materials and methods</h4>We conducted a systematic search in MEDLINE and LILACS from 1990 to June, 2016 with the following combinations of key words "tuberculosis AND transmission" OR "tuberculosis diabetes mellitus" OR "Mycobacterium tuberculosis molecular epidemiology" OR "RFLP-IS6110" OR "Spoligotyping" OR "MIRU-VNTR". Studies were included if they met the following criteria: (i) studies based on populations from defined geographical areas; (ii) use of genotyping by IS6110- restriction fragment length polymorphism (RFLP) analysis and spoligotyping or mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) or other amplification methods to identify molecular clustering; (iii) genotyping and analysis of 50 or more cases of PTB; (iv) study duration of 11 months or more; (v) identification of quantitative risk factors for molecular clustering including DM; (vi) > 60% coverage of the study population; and (vii) patients with PTB confirmed bacteriologically. The exclusion criteria were: (i) Extrapulmonary TB; (ii) TB caused by nontuberculous mycobacteria; (iii) patients with PTB and HIV; (iv) pediatric PTB patients; (v) TB in closed environments (e.g. prisons, elderly homes, etc.); (vi) diabetes insipidus and (vii) outbreak reports. Hartung-Knapp-Sidik-Jonkman method was used to estimate the odds ratio (OR) of the association between DM with molecular clustering of cases with TB. In order to evaluate the degree of heterogeneity a statistical Q test was done. The publication bias was examined with Begg and Egger tests. Review Manager 5.3.5 CMA v.3 and Biostat and Software package R were used.<h4>Results</h4>Selection criteria were met by six articles which included 4076 patients with PTB of which 13% had DM. Twenty seven percent of the cases were clustered. The majority of cases (48%) were reported in a study in China with 31% clustering. The highest incidence of TB occurred in two studies from China. The global OR for molecular clustering was 0.84 (IC 95% 0.40-1.72). The heterogeneity between studies was moderate (I2 = 55%, p = 0.05), although there was no publication bias (Beggs test p = 0.353 and Eggers p = 0.429).<h4>Conclusion</h4>There were very few studies meeting our selection criteria. The wide confidence interval indicates that there is not enough evidence to draw conclusions about the association. Clustering of patients with DM in TB transmission chains should be investigated in areas where both diseases are prevalent and focus on specific contexts.https://doi.org/10.1371/journal.pone.0184675 |
| spellingShingle | Francles Blanco-Guillot Guadalupe Delgado-Sánchez Norma Mongua-Rodríguez Pablo Cruz-Hervert Leticia Ferreyra-Reyes Elizabeth Ferreira-Guerrero Mercedes Yanes-Lane Rogelio Montero-Campos Miriam Bobadilla-Del-Valle Pedro Torres-González Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes Garcia-Garcia Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. PLoS ONE |
| title | Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_full | Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_fullStr | Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_full_unstemmed | Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_short | Molecular clustering of patients with diabetes and pulmonary tuberculosis: A systematic review and meta-analysis. |
| title_sort | molecular clustering of patients with diabetes and pulmonary tuberculosis a systematic review and meta analysis |
| url | https://doi.org/10.1371/journal.pone.0184675 |
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