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Shao Changzhou* Qu Jieming*1 He Lixian
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
Abstract Setting Tuberculous infection is re-emerging as a major health care concern. More and more immunosuppressive therapy has contributed to this infection. Studies on the difference between immunocompromised patients (ICPs) and non-immunocompromised patients (non-ICPs) are few. Objective To study on the clinical manifestations of ICPs and non-ICPs with tuberculosis comparatively. Methods To analyze 115 tuberculosis cases retrospectively, including 39 ICPs and 76 non-ICPs with tuberculosis by use of SPSS statistical software. Results Compared with non-ICPs: ICPs group had more expectoration sputum(64.10% Vs 35.53%), pulmonary moist rales (41.02% Vs 9.21%), military pulmonary tuberculosis (30.77% Vs 2.63%), pleural effusions(48.72％ Vs 25.00％) and lymphadenopathy (17.95％ Vs 3.95％), however, they had less lung cavitation (15.38% Vs 22.37％) and pleural thickening (15.38％Vs23.68％), which were misdiagnosed as pneumonia (23.08％ Vs 6.58％) . Pulmonary tuberculosis was found in apicoposterior segment (SI+SII) in more cases in non-ICPs (21.74%, 10/46 cases) than in ICPs ( 10.34%,3/29 cases). The diagnostic value of tuberculin skin test and adenosine deaminase in pleural effusion was limited in ICPs. ICPs had a significantly poorer prognosis than non-ICPs. Conclusion Different from non-ICPs, the clinical manifestations of ICPs with tuberculosis were atypical, which would lead to misdiagnosis and bad prognosis. Clinician should emphasize this in the diagnosis and treatment of tuberculosis in ICPs.
Key Words Immunocompromised patient; Pulmonary tuberculosis; Clinical manifestations ; Misdiagnosis
A large part having been taken by immunocompromised patients ( ICPs ), the nature of the infection caused by Mycobacterium tuberculosis has changed during the last decades. As their cell-mediated immunity (CMI) was destroyed, those individuals receiving immunosuppressive therapy because of cancer, organ transplantation and various other conditions and patients infected human immunodeficiency virus (HIV) are particularly susceptible to develop tuberculosis. In order to understand that whether their clinical presentations changed or not, which was influenced by an underlying disease and lead to a delay in the correct diagnosis and treatment, this comparative study was designed to collect and analyze 115 cases of tuberculosis statistically between ICPs resulting from immunosuppressive therapy and non-ICPs. The main focus is on the differences in clinical presentations, radiological findings, delay of early diagnosis, treatment and prognosis of pulmonary tuberculosis between ICPs and non-ICPs.
Patiens and methods
Patients There were total 145 culture-positive tuberculosis cases in Zhongshan hospital of Fudan university during the year 1995-2001, of which the medical records were available in 141 cases. There were 39 ICPs and 76 non-ICPs with underlying diseases possibly predisposing to tuberculosis but who did not received immunosuppressive treatment in them. No HIV infection were found in these patients. The other 26 patients with no known predisposing factor were excluded in this study.
Criterion of ICPs: patients had received systemic corticosteroids more than 2 months, cytotoxic agents as chemotherapy for 3 cycles or longer, or cyclosporine within 1 year prior to the diagnosis of tuberculosis or who had previously been given radiotherapy.
Mycobacterial culture Specimens of tuberculosis was taken from expectoration sputum, aspiration of endotracheal intubation, fibrobronchoscopic specimens (mainly broncho-alveolar lavage), pleual effusion,lung and other tissues biopsy. M.tuberculosis was cultured for about 38 days by using Lowenstein-Jensen medium.
Statistical methods Analysis was performed by SPSS statistical soft ware 10.0. Differences of two groups in percentages were compared with use ofχ2 test. Differences between continuous variables in two groups were compared by using of “t” test.
Results
General information 39 cases were tuberculosis in ICPs, including 23 men and 16 women, aged from 19 to 66 years old, whose average age was 43.26±11.69 years. Other pathogens (mainly pseudomonas aeruginosa, staphylococcus aureus, aspergillus, mycoplasma and pneumocystis carinii) were found in 12 cases. In contrast, non-ICP group was composed of 55 men and 21 women, who were 20-72 years old (averaged 41.82±15.58). 11 patients of them were infected by other pathogens such as Staphylococcus aureus, Escherichia coli and Streptococcus pneumoniae. M.tuberculosis was isolated mainly from sputum, fibrobronchoscopic specimens and pleural fluids (table 1). 21 patients had a known previous episode of tuberculosis (20.51% of ICPs, 17.11% of non-ICPs, P value not significant). Of those patients ≥50 years of age, 26.23% (16 of 61) had a history of tuberculosis, but only 9.26% (5 of 54) of the younger patients did (P <0.05).
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作者:admin@医学,生命科学 2011-02-15 05:11
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