Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies
Journal
BMC Infectious Diseases
Journal Volume
11
Pages
324
Date Issued
2011
Abstract
Background: Diseases caused by Mycobacterium tuberculosis (TB) among adult patients with hematological malignancies have rarely been investigated.Methods: Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s) in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes.Results: Fifty-three of 2984 patients (1.78%) were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41). Thirty-eight patients (72%) with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%), pleural effusion (47%) and fibrocalcific lesions (43%) on chest imaging. The 15 (28%) patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03) and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004) compared to those with disease confined to the lungs.Conclusions: TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity. ? 2011 Chen et al; licensee BioMed Central Ltd.
SDGs
Other Subjects
ethambutol; isoniazid; pyrazinamide; quinolone derivative; rifampicin; streptomycin; tuberculostatic agent; acute granulocytic leukemia; adult; aged; antimicrobial therapy; article; bacterium culture; clinical feature; controlled study; disease association; drug resistance; extrapulmonary tuberculosis; febrile neutropenia; female; hematologic malignancy; human; incidence; lung disease; lung tuberculosis; lymphadenopathy; major clinical study; male; mortality; outcome assessment; pleura effusion; retrospective study; Taiwan; thorax radiography; treatment response; tuberculosis; blood disease; isolation and purification; microbiology; middle aged; Mycobacterium tuberculosis; pathology; treatment outcome; tuberculosis; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Female; Hematologic Neoplasms; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Retrospective Studies; Taiwan; Treatment Outcome; Tuberculosis
Type
journal article