The Convergence of Infectious Diseases and Noncommunicable Diseases Proceedings of a Workshop (2019) / Chapter Skim
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4 Risks Posed by Chronic Diseases to the Development and Severity of Infectious Diseases
4 Risks Posed by Chronic Diseases to the Development and Severity of Infectious Diseases
Pages 39-50
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From page 39... ...
METABOLIC SYNDROME AND THE RISK FOR ENTERIC INFECTION Christoph Thaiss, assistant professor of microbiology at the University of Pennsylvania Perelman School of Medicine, explained that environmental factors influence susceptibility for many common diseases, including metabolic diseases like obesity and diabetes as well as general inflammatory diseases. A 2015 study of tens of thousands of people in Denmark concluded that a high body mass index (BMI)
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From page 40... ...
Thaiss explained that this type of massive colonization never occurs in wild-type mice because Citrobacter rodentium is a self-limiting infection that stays in the gastrointestinal tract unless there is a barrier problem. Hyperglycemia Drives Susceptibility to Enteric Infection Thaiss explained that to test the presumed association between obesity and enteric infection, the next step was a paired feeding experiment.
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From page 41... ...
Epithelial Glucose Metabolism Influences Barrier Function Thaiss ended his presentation by explaining how epithelial glucose metabolism may influence barrier function in a person with diabetes. As glucose follows a retrograde flow into intestinal epithelial cells, it leads to glucose metabolism in the cell and transcriptional and epigenetic
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From page 42... ...
CONVERGING EPIDEMICS OF DIABETES AND TUBERCULOSIS Julia Critchley, professor of epidemiology at the Population Health Research Institute, St. George's University of London, examined the epidemiology and public health consequences of the converging epidemics of TB and diabetes.
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From page 43... ...
. Evidence from observational studies, prospective cohorts, and case control studies shows that people with diabetes have roughly double the risk of developing active TB (Restrepo et al., 2011)
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From page 44... ...
Multiple systematic reviews have looked at TB treatment outcomes among people with diabetes. A 2011 review suggested that diabetes worsens treatment outcomes among TB patients, but the included studies were relatively poor in quality and relied on observational data (Baker et al., 2011)
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From page 45... ...
She said, "We are only really helping people if we can manage their diabetes better after the end of TB treatment." Critchley summarized her presentation making the following main points: • Diabetes increases the risk of TB disease (even when the mechanism is not fully understood) , and it increases the risk of poor TB treatment outcomes, particularly mortality.
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From page 46... ...
Kester also asked Thaiss if they were able to restore some of the barrier effect in their mice studies, while still controlling for the impaired leukocyte function when hyperglycemia is present. Thaiss replied that the restoration achieved by preventing epithelial dysfunction is not complete, so some of the residual problems may be accounted for by impaired immune function.
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From page 47... ...
Critchley added that the TANDEM study included blood glucose and HbA1c testing, and the results were similar in terms of screening accuracy, although their data mainly identified people who had already been diagnosed with diabetes. She added that data from studies in Africa have found associations of different strength with HbA1c versus blood glucose markers of diabetes.
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From page 48... ...
She used as an example settings without the laboratory capacity to provide reliable HbA1c results, or where the only test available requires fasting on a person with TB receiving treatment. Most low-resource TB patients in Peru receive a food basket with high-carbohydrate foods to supplement their diets, she noted.
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From page 49... ...
Data would improve if funders were prepared to invest in longitudinal studies. Reorganizing health systems to deliver integrated care could be supported by the recent sets of guidelines that provide simple frameworks for primary care clinics in rural settings to deal with suspected diabetes.
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