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Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies.

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.

journal_name

BMC Infect Dis

journal_title

BMC infectious diseases

authors

Chen CY,Sheng WH,Cheng A,Tsay W,Huang SY,Tang JL,Chen YC,Wang JY,Tien HF,Chang SC

doi

10.1186/1471-2334-11-324

subject

Has Abstract

pub_date

2011-11-23 00:00:00

pages

324

issn

1471-2334

pii

1471-2334-11-324

journal_volume

pub_type

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Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies.