Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Am J Trop Med Hyg. 2023 Aug 21;109(4):733-739. doi: 10.4269/ajtmh.23-0023. Print 2023 Oct 4.
Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44-67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.
全球范围内，有一半的肺结核（PTB）患者是临床诊断而未经细菌学确认的。在临床诊断为 PTB 的患者中，我们评估了通过参考标准诊断性测试可在细菌学上确认 PTB 的患者比例，以及模拟 PTB 的疾病的流行率。我们于 2019 年在坦桑尼亚莫希招募了开始接受未经细菌学证实的 PTB 治疗的成年患者。我们对两份诱导痰样本进行了分枝杆菌涂片、Xpert MTB/RIF Ultra、分枝杆菌培养、真菌培养和细菌培养：真菌血清学和胸部 CT 扫描。我们在入组后随访参与者 2 个月。我们共入组了 57 例未经细菌学证实的 PTB 患者中的 36 例（63%）。患者的中位（四分位距）年龄为 55（44-67）岁。6 例（17%）感染了 HIV。我们在 2 例（6%）中细菌学上确认为 PTB。我们在 23 例中的 23 例（48%）中发现了肺炎，在 23 例中的 8 例（35%）中发现了支气管扩张症，在 23 例中的 5 例（22%）中发现了间质性肺病，在 23 例中的 5 例（22%）中发现了胸腔积液，在 23 例中的 1 例（4%）中发现了肺部恶性肿瘤，在 35 例中的 1 例（3%）中发现了慢性肺曲霉病。2 个月后，有 4 例（11%）死亡，21 例（58%）持续有症状，6 例（17%）康复，5 例（14%）无法联系。在临床诊断为 PTB 的患者中，很少有患者可在细菌学上确认 PTB，且临床结局较差，这表明许多患者并未患该病。我们发现除结核病以外的许多疾病的流行率较高，这些疾病可能是导致症状的原因。
