International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359640, Seattle, WA, 98104, USA.
BMC Pulm Med. 2019 Mar 11;19(1):60. doi: 10.1186/s12890-019-0828-4.
Cambodia, a lower middle-income country of about 16 million individuals in southeast Asia, endures a high burden of both tuberculosis and other lower respiratory infections. Differentiating tuberculosis from other causes of respiratory infection has important clinical implications yet may be challenging to accomplish in the absence of diagnostic microbiology facilities. Furthermore, co-infection of tuberculosis with other bacterial lower respiratory infections may occur. The objective of this study was to determine the prevalence and etiologies of tuberculosis and other bacterial co-infection and to analyze the clinical and radiographic characteristics of patients presenting with respiratory infection to a provincial referral hospital in Cambodia.
We performed a retrospective, cross-sectional analysis of laboratory and clinical data, on patients presenting with respiratory symptoms to a chest clinic of a 260-bed provincial referral hospital in Cambodia. We analyzed mycobacterial and bacterial sputum test results, and demographics, medical history and chest radiography.
Among 137 patients whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, the median age was 52 years, 54% were male, 3% had HIV infection, and 26% were current smokers. Nearly all had chronic respiratory symptoms (> 96%) and abnormal chest radiographs (87%). Sputum testing was positive for tuberculosis in 40 patients (30%) and for bacteria in 60 patients (44%); 13 had tuberculosis and bacterial co-infection (9% overall; 33% of tuberculosis patients). Clinical characteristics were generally similar across pulmonary infection types, although co-infection was identified in 43% of patients with one or more cavitary lesions on chest radiography. Among those with bacterial growth on sputum culture, Gram negative bacilli (Klebsiella and Pseudomonas spp.) were the most commonly isolated.
Among patients with symptoms of respiratory infections whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, 9% of all patients and 33% of tuberculosis patients had tuberculosis and bacterial co-infection. Greater availability of microbiologic diagnostics for pulmonary tuberculosis and bacterial infection is critical to ensure appropriate diagnosis and management.
柬埔寨是东南亚一个拥有约 1600 万人口的中下等收入国家，结核病和其他下呼吸道感染负担沉重。从其他引起呼吸道感染的病因中鉴别出结核病具有重要的临床意义，但在缺乏诊断微生物学设施的情况下，可能难以实现。此外，结核病可能与其他细菌性下呼吸道感染合并感染。本研究旨在确定结核病和其他细菌性合并感染的流行率和病因，并分析在柬埔寨一家省级转诊医院因呼吸道感染就诊患者的临床和影像学特征。
我们对在柬埔寨一家 260 张床位的省级转诊医院胸科诊所因呼吸道症状就诊的患者进行了实验室和临床数据的回顾性、横断面分析。我们分析了分枝杆菌和细菌痰液检测结果以及人口统计学、病史和胸部 X 线摄影结果。
在 137 名接受治疗的临床医生为结核病和其他细菌开痰液检测的患者中，中位年龄为 52 岁，54%为男性，3%感染了 HIV，26%为当前吸烟者。几乎所有人都有慢性呼吸道症状（＞96%）和异常的胸部 X 线摄影（87%）。40 名患者（30%）的痰液检测结果呈结核病阳性，60 名患者（44%）的痰液检测结果呈细菌阳性；13 名患者结核病和细菌合并感染（总体 9%；结核病患者中 33%）。尽管在胸部 X 线摄影显示一个或多个空洞病变的患者中，43%的患者中发现了合并感染，但各种肺部感染类型的临床特征通常相似。在痰液培养有细菌生长的患者中，革兰氏阴性杆菌（克雷伯菌属和假单胞菌属）最常被分离。
在因呼吸道感染症状而接受治疗的临床医生为结核病和其他细菌开痰液检测的患者中，所有患者中有 9%，结核病患者中有 33%存在结核病和细菌合并感染。更广泛地提供针对肺结核和细菌感染的微生物诊断对于确保适当的诊断和管理至关重要。
