Clinical Characteristics and Radiologic Features of Immunocompromised Patients With Pauci-Bacillary Pulmonary Tuberculosis Receiving Delayed Diagnosis and Treatment

Author:

Park Joung Ha1,Choe Jooae2,Bae Moonsuk1,Choi Sungim1,Jung Kyung Hwa1,Kim Min Jae1,Chong Yong Pil1,Lee Sang-Oh1,Choi Sang-Ho1,Kim Yang Soo1,Woo Jun Hee1,Jo Kyung-Wook3,Shim Tae Sun3,Kim Mi Young2,Kim Sung-Han2ORCID

Affiliation:

1. Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

2. Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

3. Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

Abstract

Abstract Background Pauci-bacillary pulmonary tuberculosis (TB) can be delayed to diagnose and start anti-TB therapy, especially in immunocompromised patients. We therefore evaluated the clinical and radiologic features of these delayed cases. Methods Immunocompromised adult patients with pauci-bacillary pulmonary TB were retrospectively enrolled in a tertiary hospital in an intermediate–TB burden country over a 5-year period. We defined “missed TB” or “not-missed TB” patients as those who started anti-TB therapy after or before positive mycobacterial culture results, respectively. Results Of 258 patients, 134 (52%) were classified in the missed TB group, and 124 (48%) in the not-missed TB group. Positive results of molecular tests including MTB polymerase chain reaction and/or Xpert TB/RIF were only obtained in the not-missed TB group (54/106, 54%). The median diagnostic delay in the missed TB group was longer than in the other group (30 vs 6 days; P < .001). In the missed TB group, the most common working diagnoses were pneumonia (46, 34%) and lung metastasis of malignancy (40, 30%). Typical radiologic findings for TB, such as upper lobe predominance and centrilobular nodules with tree-in-bud appearance, were less common in the missed TB group than in the other group. Old age (odds ratio [OR], 1.03), solid organ transplant (OR, 3.46), solid tumor (OR, 3.83), and hematologic malignancy (OR, 4.04) were independently associated with missed TB. Conclusions Care is needed to differentiate pauci-bacillary TB, especially in immunocompromised patients with the mentioned risk factors, even without the usual radiologic features of TB. Additional rapid diagnostic tests to rule out pauci-bacillary TB are urgently needed.

Funder

National Research Foundation of Korea

Ministry of Science, ICT & Future Planning

Asan Institute for Life Sciences

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

Reference24 articles.

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2. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence;Siddiqi;Lancet Infect Dis,2003

3. The diagnosis and misdiagnosis of tuberculosis;Davies;Int J Tuberc Lung Dis,2008

4. Diagnostic standards and classification of tuberculosis in adults and children;American Thoracic Society;Am J Respir Crit Care Med,2000

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