Comparison Between Acid Fast Bacilli

(AFB) Smear Result for Mycobacterium

tuberculosis on Adult Pulmonary
Tuberculosis (TB) Patients with Type 2
Diabetes Mellitus (DM) and AFB Smear
Result for M.tuberculosis on Adult
Pulmonary TB Patients without Type 2
DM
 INTRODUCTION

 Global Tuberculosis Report 2014, Indonesia is included in

the top six countries in the world with the highest
number of pulmonary TB cases after India, China, Nigeria,
Pakistan and South Africa.
 Global Tuberculosis Report 2015, Indonesia rises to second
place in the world with the largest number of pulmonary
TB cases after India.
 INTRODUCTION
• DM is one of the important risk factors in the occurrence
of TB inflammation. Clinicians have observed an
association between DM and TB, although it is still
difficult to determine whether DM precedes TB or TB that
leads to clinical manifestations of DM. It is now known
that DM patients have impaired the body's immune
response so as to facilitate M. tuberculosis infection and
cause TB.
 OBJECTIVES

To know comparison between acid fast bacilli (AFB) smear

result for Mycobacterium tuberculosis on adult pulmonary
tuberculosis (TB) patients with type 2 diabetes mellitus
(DM) and AFB smear result for M.tuberculosis on adult
pulmonary TB patients without type 2 DM
 MATERIALS AND METHODS

 Comparative research
 Cross-sectional study

 Was conducted in November 2016 at General

Hospital of class C Jakarta

 Observation of variables in this research by

medical records
 MATERIALS AND METHODS

Diagnosis of pulmonary TB in adults in this study was

established first with bacteriological examination.
Bacteriological examination is a direct microscopic
examination of acid fast bacilli (AFB) smear with
interpretation of results according to International
Union Agains Tuberculosis and Lung Disease (IUALTD).
 POPULATION AND SAMPLES
POPULATION
All adult pulmonary TB patients at General Hospital of Class C
Jakarta period October 1, 2013 - March 31, 2016 (458 patients)

Inclusion criteria :
 Pulmonary TB patients >
18 years
Exclusion criteria :
 Adult pulmonary TB
 Extrapulmonary TB
patients with type 2 DM
patients
 Adult pulmonary TB
 Pulmonary TB patients
patients without type 2 DM
with type 1 DM
 Patient with complete
data and medical record
number

SAMPLES
225 patients
RESULTS
RESULTS
 RESULTS
Characteristics N Percentage (%)
Clinical symptoms Chest pain 60 74,07
on adult Difficulty 67 82,72
pulmonary TB breathing
patients with
type 2 DM Cough ≥ 2 weeks 77 95,06
Hemoptysis 58 71,6
Night sweats 61 75,3
Weight ↓ 65 80,25
Fever 58 71,6
Anorexia 64 79,01
Malaise 66 81,48
AFB conversion Conversion 38 86,36%
on adult Not conversion 0 0
pulmonary TB
patients with
type 2 DM
 RESULTS
Characteristics N Percentage (%)
Clinical symptoms Chest pain 97 67,36
on adult Difficulty 118 81,94
pulmonary TB breathing
patients without
type 2 DM Cough ≥ 2 weeks 134 93,06
Hemoptysis 81 56,25
Night sweats 96 66,67
Weight ↓ 106 73,61
Fever 110 76,39
Anorexia 106 73,61
Malaise 91 63,19
AFB conversion Conversion 20 71,43
on adult Not conversion 1 3,57
pulmonary TB
patients without
type 2 DM
 RESULTS

AFB AFB
Chi-Square
Mann-Whitney
test test P value CI 95% P value
OR
(3+/2+/1+) –
(3+/2+/1+) – (Negative)
Adult pulmonary TB (Negative
44 ) 37
patients with type 2 DM
0,000
Adult pulmonary TB
Adult pulmonary TB 44 37
patients with type 2 28 112 0,115 –
patients without type 2 0,000 0,210
DMDM 0,384
Adult pulmonary TB 28 AFB
112
Chi-Square
patients test
without P value
type 2 DM 3+ 2+ 1+ –

Adult pulmonary TB 14 15 15 37
patients with type 2 DM
0,000

Adult pulmonary TB 3 6 19 112

patients without type 2
DM
 DISCUSSION
• The
AFB most
smearcommon
with negative
gender areresult
male most
→ Alisjahbana
found in this
et
al., Park→etFengling
research al., Wang
et al.,
et Park
al., etFengling
al. and Dooley
et al.,etSyed
al.
• Sulaiman
AFB smearetwith al.,positive
Dobler result
et al.,
wereDooley
more et al., Ruth
prevalent in
Haryanti
patients et al. DM type 2 → Park et al., Wang et al.,
with
• Fengling
The mostetcommon
al. Dooley
age are
et al.,
groups
Sukara
25 –Safri
34 years
et al.→and
Sri
Melati Wijayanto
Agung et al. et al.
• AFB
The conversion
most common at the patient
end of intensive
type are phasenew→ case
Fengling
→
Fengling
et al., Iiset
Kurniati
al. andand
RuthRuth
Haryanti
Haryanti
et al.
et al.
• There
The most
was a common
statistically
treatment
significantresult
association
are complete
between
treatment
type 2 DM → andWang
AFB etsmear
al. result → Wang et al., Park et
• al.,
The Fengling et al. and
most common Agung symptoms
clinical Wijayanto et areal.cough ≥ 2
weeks → Park et al., Wang et al. and Indra Wijaya.
 WEAKNESS OF RESEARCH

 In this study, there was no balance between

samples of adult pulmonary TB patients with
type 2 diabetes mellitus and adult pulmonary TB
patients without type 2 diabetes mellitus.
 Very few adult pulmonary TB patients have
laboratory test results for HbA1c levels.
 KESIMPULAN
 Adult pulmonary tuberculosis patients with AFB
positive smear result (1 + / 2 + / 3 +) were more
common in adult pulmonary TB patients with type 2
diabetes mellitus than adult pulmonary TB patients
without type 2 diabetes mellitus.
 The most common gender are male, most common
age are groups 25 – 34 years, most common patient
type are new case, most common treatment result
are complete treatment, most common clinical
symptoms are cough ≥ 2 weeks