Tuberculosis revisited: a 10-year experience from a tertiary hospital outpatient infectious diseases clinic
Abstract number: R2677
Fragou A., Nikou P., Poulakou G., Oikonomou A., Paramythiotou E., Kontos F., Zerva L., Kanellakopoulou K., Petrikkos G., Antoniadou A.
Objectives: To evaluate definite cases of mycobacterium tuberculosis (MTB) infections, according to ATS criteria.
Methods: Retrospective chart review of 10year outpatient visits in the infectious diseases department of a tertiary hospital.
Results: Among 110 referred patients (pts) with suspected TB, 85 definite cases were documented and analyzed [male 39 (45.9%), age: median 59ys, range 2193ys, caucasian 71pts (91.2%)]. In 49 pts (57.6%), no risk factor (RF) for TB was recognized. Among the rest, the most prominent RF was underlying malignancy [11pts (30.6%)], followed by diabetes mellitus [8 pts (22.2%)] and steroid use [7pts (19.4%)]. Pulmonary TB was present in12 pts (14.1%), pleural in 4 (4.7%), extrathoracic lymphadenopathy 22 (25.9%), bone and joint infection 9 (10.6%), spinal TB 15 (17.6%), 9 CNS (10.6%), urinary tract 6 (7.1%), abdominal 5 pts (5.6%). Fever was present in 36.5%, appetite and/or weight loss in 14.1%, cough in 16.5%, bone-joint pain in 23.4% and neurological signs in 11.8% (the last two directly related to the site of infection).
Plain chest radiography (PR) was positive in 36.5% and CT scan in 46% of pts adding significant diagnostic clues. Direct sputum examination (DE) was positive in 36.5%; in 55% of them plain radiograph was insignificant. Cultures were positive in 50pts (58.8%); in 50% of them DE was negative. PCR was positive in 27/28 cases, contributing to the diagnosis of 17 additional cases; the same was true for 11 biopsies. Among 48 sensitivity tests 89.6% revealed fully sensitive MTB, whereas only two were multidrug-resistant.
Median duration of treatment was 9 months (mo) [range 224]; for pulmonary TB 6mo. Drug toxicity experienced 21/85 pts (24.7%), mostly as liver toxicity attributed to rifampin. Successful treatment was confirmed in 73/78 (93.6%); 7 pts (8.2%) were lost to follow-up. Among 4 pts who failed treatment, 3 died (mortality 3.8%).
Conclusions: Traditional diagnostic methods (DE, cultures, PR) retain a singificant diagnostic value, which can be significantly augmented by the addition of newer diagnostic techniques as CT and PCR. Molecular methods added importantly in the diagnosis of extrapulmonary TB. Particularities of the population served by our reference center could probably explain the epidemiological features observed regarding risk factors and clinical picture.
|Session name:||Abstracts of 21st ECCMID / 27th ICC|
|Location:||Milan, Italy, 7 - 10 May 2011|
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