• Tuberculosis

One woe doth tread upon another's heel, So fast they follow. William Shakespeare. Hamlet. Act 1V Scene V11

We are approaching a day and age where the terms communicable and non-communicable diseases are taking on a new meaning. In the epidemiology and global public health space we track the top five causes of death to measure how well we are doing in combating illness.1 The idea that tuberculosis (TB) and diabetes mellitus (DM) share a synergistic relationship has been creating a growing stir around the world. This is so in the developed world where non-communicable diseases remain the leading cause of death and the developing world where the ‘diabesity’ epidemic is rapidly expanding to possibly overshadow the traditional killers from communicable disease.2 Of what relevance are these classifications in a patient unfortunate enough to have TB and DM? What, if anything, should we do differently in our clinics when a classical non-communicable illness like DM accelerates and amplifies the course of an age-old, communicable infection like TB? As the dreaded Mycobacterium grows deadlier with time, none of us want to see it develop new allies. The study published by Jimenez-Corona et al 3 in this edition of Thorax suggests we have reason to be concerned. It also needs to be lauded upfront for being a major effort at identifying, exploring and characterising the TB-DM connection. They present a 15 year prospective follow-up of this growing area of concern. Indeed in the years since they started collecting data, numerous reports have emerged addressing the same concept in India,4 Brazil5 and the US-Mexico border.6 The study by Jiminez-Corona has several merits worth noting. They followed a large sample size totalling 1262 patients with pulmonary TB (PTB), and found a high prevalence of …