Journal
OPEN FORUM INFECTIOUS DISEASES
Volume 6, Issue 2, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofz002
Keywords
immunocompromised; pauci-bacillary; tuberculosis
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Funding
- National Research Foundation of Korea - Ministry of Science, ICT & Future Planning [NRF-2018R1D1A1A09082099]
- Asan Institute for Life Sciences [2018-7040]
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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.
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