The mask of acute bacterial pneumonia may disguise the face of tuberculosis
Keywords:
Pneumonia, Tuberculosis, Community-Acquired PneumoniaAbstract
Introduction: Pulmonary tuberculosis (TB) can present as acute pneumonia. Differentiation of tuberculous from non-tuberculous community-acquired pneumonia (CAP) is an important challenge in endemic areas. The purpose of this study was the comparison between characteristics of tuberculous and non-tuberculous CAP patients.
Methods: In this prospective and observational study, all adult patients (aged ≥16 years) who were admitted to Imam Reza Hospital in Mashhad (Iran) with the diagnosis of CAP, between February 2013 and January 2014, were enrolled. Clinical, radiological, and microbiological data of the patients were collected and reviewed. Statistical analyses were performed using SPSS 14 software and R programming language.
Results: We studied 120 patients with diagnosis of acute CAP including 21 (17.5%) tuberculous and 99 (82.5%) non-tuberculous CAP. The etiologies of CAP in the latter group were as follow: S. pneumoniae 29 (29.3%), followed by S. aureus, polymicrobial including anaerobes, and other agents. The diagnosis of pneumonia remained unknown in 49 (40%) patients. We found approximately equal gender distribution among two study groups (14/21 vs. 61/99, 63.6% vs. 62.9%, p=0.948). Fifty percent of patients with tuberculous CAP had opioid addiction that was more frequent compared with non-tuberculous group (p=0.240). 52.4%, 63.2%, 30%, and 90% of patients with tuberculous CAP had severe presentation based on PSI, IDSA/ATS, CURB-65, and SMART-COP, respectively.
Conclusions: The diagnosis of TB should be considered in all patients who presented with CAP in endemic regions. It could not be differentiated from other causes of pneumonia on clinical and radiological grounds.
References
Azizi MH, Bahadori M. A brief history of tuberculosis in Iran during the 19th and 20th centuries. Arch Iran
Med. 2011; 14(3): 215-9. doi: 011143/AIM.0018. PMID: 21529117.
WHO Global Tuberculosis report 2015. Available from: http://www.who.int/tb/country/data/profiles/en/.
Alavi SM, Salmanzadeh Sh, Bakhtiyariniya P, Albagi A, Hemmatnia F, Alavi L. Prevalence and treatment
outcome of pulmonary and extrapulmonary pediatric tuberculosis in southwestern Iran. Caspian J Intern
Med. 2015; 6(4): 213–9. PMID: 26644895, PMCID: PMC4649270.
Lotfian F, Bolursaz MR, Khalilzadeh S, Baghaie N, Hassanzad M, Velayati AA. Features of Adolescents
Tuberculosis at a Referral TB’s Hospital in Tehran, Iran. Mediterr J Hematol Infect Dis. 2016; 8(1):
e2016005. doi: 10.4084/MJHID.2016.005. PMID: 26740866, PMCID: PMC4696473.
Peto L, Nadjm B, Horby P, Ngan TT, van Doorn R, Kinh NV, et al. The bacterial aetiology of adult
community-acquired pneumonia in Asia: a systematic review. Trans R Soc Trop Med Hyg. 2014; 108(6):
-37. doi: 10.1093/trstmh/tru058. PMID: 24781376, PMCID: PMC4023908.
Schlossberg D. Acute tuberculosis. Infect Dis Clin North Am. 2010; 24(1): 139-46. doi:
1016/j.idc.2009.10.009. PMID: 20171549.
Ministry of Public Health and Education of Iran. Tuberculosis Situation In Iran. 2013. Available from:
http://tb-lep.behdasht.gov.ir/TB_Situation_in_Iran.aspx.
Naderi H, Sheybani F, Sarvghad M, Meshkat Z, Nooghabi MJ. Etiological Diagnosis of Community- Acquired Pneumonia in Adult Patients: A Prospective Hospital-Based Study in Mashhad, Iran. Jundishapur
J Microbiol. 2015; 8(8). doi: 10.5812/jjm.22780. PMID: 26464771, PMCID: PMC4600341.
Wasan A, Butler SF, Budman SH, Fernandez K, Weiss R, Greenfield Sh. et al. Does Report of Craving
Opioid Medication Predict Aberrant Drug Behavior Among Chronic Pain Patients? Clin J Pain. 2009;
(3): 193–198. doi: 10.1097/AJP.0b013e318193a6c4. PMID: 19333168, PMCID: PMC2664529.
Dooley KE, Golub J, Goes FS, Merz WG, Sterling TR. Empiric treatment of community-acquired
pneumonia with fluoroquinolones, and delays in the treatment of tuberculosis. Clin Infect Dis. 2002;
(12): 1607-12. PMID: 12032896.
Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized
community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the
United States. Am J Respir Criti Care Med. 2002; 165(6):766-72. doi: 10.1164/ajrccm.165.6.2103038.
PMID: 11897642.
Gatey C, Tattevin P, Rioux C, Ducot B, Meyer L, Bouvet E. Impact of early chest radiography and
empirical antibiotherapy on delay in the diagnosis of pulmonary tuberculosis. Med Mal Infect. 2012; 42(3):
-3. doi: 10.1016/j.medmal.2011.12.003. PMID: 22398329.
Nyamande K, Lalloo UG, John M. TB presenting as community-acquired pneumonia in a setting of high
TB incidence and high HIV prevalence. Int J Tuberc Lung Dis. 2007; 11(12): 1308-13. PMID: 18034951.
Asnis DS, Cherian S, Sun T, Shrestha S, Santucci T. Pulmonary tuberculosis presenting as community- acquired pneumonia. Clin Infect Dis. 2002; 35(12): 1574-1575. PMID: 12471584.
Scott JA, Hall AJ, Muyodi C, Lowe B, Ross M, Chohan B, et al. Aetiology, outcome, and risk factors for
mortality among adults with acute pneumonia in Kenya. Lancet. 2000; 355(9211): 1225-30. PMID:
16) Lévy M, Dromer F, Brion N, Leturdu F, Carbon C. Community-acquired pneumonia. Importance of initial
noninvasive bacteriologic and radiographic investigations. Chest. 1988; 93(1): 43-8. PMID: 3275531.
Liam CK, Pang YK, Poosparajah S. Pulmonary tuberculosis presenting ascommunity-acquired pneumonia.
Respirology. 2006; 11(6): 786-92. doi: 10.1111/j.1440-1843.2006.00947.x. PMID: 17052309.
Kunimoto D, Long R. Tuberculosis: still overlooked as a cause of community-acquired pneumonia--how
not to miss it. Respir Care Clin N Am. 2005; 11(1): 25-34. doi: 10.1016/j.rcc.2004.10.007. PMID: 15763219.
Naderi M, Hashemi M, Kouhpayeh H, Ahmadi R. The status of serum procalcitonin in pulmonary
tuberculosis and nontuberculosis pulmonary disease. J Pak Med Assoc. 2009; 59(9): 647-648. PMID:
Ugajin M, Miwa S, Shirai M, Ohba H, Eifuku T, Nakamura H, et al. Usefulness of serum procalcitonin
levels in pulmonary tuberculosis. Eur Respir J. 2011; 37(2): 371-5. doi: 10.1183/09031936.00011910.
PMID: 20530033.
Rasmussen TA, Søgaard OS, Camara C, Andersen PL, Wejse C. Serum procalcitonin in pulmonary
tuberculosis. Int J Tuberc Lung Dis. 2011; 15(2): 251-6. PMID: 21219690.
Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in
differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med. 2009;
(4): 337-42. doi: 10.3904/kjim.2009.24.4.337. PMID: 19949732, PMCID: PMC2784977.
Levy H, Kallenbach JM, Feldman C, Thorburn JR, Abramowitz JA. Acute respiratory failure in active
tuberculosis. Crit Care Med. 1987; 15(3): 221-5. PMID: 3469061.
Feng JY, Fang WF, Wu CL, Yu CJ, Lin MC, Ku SC, et al. Concomitant pulmonary tuberculosis in
hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: a multi-center retrospective
study. PLoS One. 2012; 7(5): e36832. doi: 10.1371/journal.pone.0036832. PMID: 22629334, PMCID:
PMC3358294.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
