Diagnostic and Therapeutic Problems of Pulmonary Tuberculosis in Patients With Systemic Rheumatic Diseases in an Intermediate Burden Area
- Diagnostic and Therapeutic Problems of Pulmonary Tuberculosis in Patients With Systemic Rheumatic Diseases in an Intermediate Burden Area
- Issue Date
- AMER COLL CHEST PHYSICIANS
- CHEST, v. 148, NO 4, Page. 1-2
- PURPOSE: Patients with rheumatic diseases have an increasing risk of opportunistic infections, particularly tuberculosis (TB). The aim of this study is to elucidate the diagnostic and treatment problems of pulmonary TB developing in patients with rheumatic diseases.
METHODS: All patients with rheumatic diseases and concurrently newly active pulmonary TB, seen at Hanyang university hospital between January 2009 and December 2011, were selected as cases. For comparison purposes, patients without rheumatic diseases, who had newly diagnosed active pulmonary TB in respiratory clinic during the same 3-year study period, were also selected as control subjects. We performed a retrospective analysis of the medical record of 30 patients suffering from active pulmonary TB with rheumatic diseases and 193 without rheumatic diseases.
RESULTS: Of 30 patients who enrolled as cases, patients with rheumatoid arthritis were 20 (66.7%). Asymptomatic patients were more frequent in rheumatic diseases than control subjects (36.7% vs. 18.7%, p =0.024). Positivity of sputum TB culture in rheumatic diseases were lower than control, significantly (30.0% vs. 54.9%, 0.011). Diagnosis of pulmonary TB in rheumatic diseases was more frequently based on histology, than control (20.0% vs. 7.3%, p=0.023). No significant difference was found between both groups in maintenance of 1st line anti-TB medication and mortality. Change of anti-TB medication due to severe adverse drug reaction was more frequent in rheumatic disease than controls, however, there was no significant difference (17.9% vs. 7.9%, 0.096).
CONCLUSIONS: This study showed that pulmonary TB patients with rheumatic diseases were less symptomatic and lower TB culture positivity in sputum, than control subjects. Although severe adverse drug reaction was frequently reported in patients with rheumatic diseases, there was no significant difference in terms of maintenance of 1st line anti-TB medication and mortality.
CLINICAL IMPLICATIONS: We might have troubles in the diagnosis of active pulmonary TB in patients with rheumatic diseases because they were less symptomatic and lower TB culture positivity in sputum, than patients without rheumatic diseases. However, pulmonary TB patients with rheumatic diseases did not differ from those without rheumatic diseases in terms of clinical outcomes.
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