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Department of Medicine, Division of Pulmonary, Allergy And Critical Care Medicine

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Allergy and Immunology | Bacterial Infections and Mycoses | Endocrine System Diseases | Immunology of Infectious Disease | Immunopathology | Infectious Disease | Microbiology | Nutritional and Metabolic Diseases | Pathological Conditions, Signs and Symptoms


Diabetes mellitus (DM) increases risk for pulmonary tuberculosis (TB) and adverse treatment outcomes. Systemic hyper-inflammation is characteristic in people with TB and concurrent DM (TBDM) at baseline, but the impact of TB treatment on this pattern has not been determined. We measured 17 plasma cytokines and growth factors in longitudinal cohorts of Indian and Brazilian pulmonary TB patients with or without DM. Principal component analysis revealed virtually complete separation of TBDM from TB individuals in both cohorts at baseline, with hyper-inflammation in TBDM that continued through treatment completion at six months. By one year after treatment completion, there was substantial convergence of mediator levels between groups within the India cohort. Non-resolving systemic inflammation in TBDM comorbidity could reflect delayed lesion sterilization or non-resolving sterile inflammation. Either mechanism portends unfavorable long-term outcomes including risk for recurrent TB and for damaging immune pathology.


cytokines, diabetes mellitus, human, immunology, infectious disease, inflammation, microbiology, tuberculosis

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Copyright © 2019, Kumar et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited.

DOI of Published Version



Elife. 2019 Jul 4;8. pii: 46477. doi: 10.7554/eLife.46477. Link to article on publisher's site

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.