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2009, Number 1

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Rev Inst Nal Enf Resp Mex 2009; 22 (1)

Association of tuberculosis and diabetes mellitus: Immunologic mechanisms involved in susceptibility

González-Hernández Y, Sada DE, Escobar-Gutiérrez A, Muños TM, Torres RM

Language: Spanish
References: 57
Page: 48-55
PDF size: 82.57 Kb.


ABSTRACT

Tuberculosis (TB) is one of the most important infectious diseases as a cause of death worldwide. Diabetes mellitus (DM) constitutes a major risk factor for TB, and in Mexican population its role as risk factor seems to be even more relevant than HIV infection. Studies in patients with type 2 DM (DM2) have shown that the risk of developing TB is 1.8 to 8 times higher than in non-diabetic population. It has also been shown that the presence of DM2 increases the failure rate to anti-tuberculous drugs and the susceptibility to infection with drug-resistant strains of M. tuberculosis. On the other hand, immunological studies in patients with DM have revealed defects in polymorphonuclear leukocytes functions (phagocytosis, opsonic activity by complement and intracellular bactericidal activity), as well as the release of IL-1 and production of IL-6, TNF-a and IFN-g by mononuclear cells. In experimental animal models, diminished production of cytokines such as IL-12, IL-6 and IL-10 is associated with high concentrations of blood glucose, suggesting a possible role of hyperglycemia in the immune response abnormality causative of increased susceptibility to infections. Alveolar macrophages from DM2 patients who develop active TB display less activation and decreased in IFN-g production. These data suggest that alterations in the innate and adaptive immune responses in patients with DM participate in the increased susceptibility to infection and in the development of active TB.


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