The coughing patient: TB or not TB; That is the question

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dc.contributor.authorLaufer, Natalia
dc.contributor.authorSued, Omar
dc.contributor.authorAbusamra, Lorena
dc.contributor.authorCabrini, Mercedes
dc.contributor.authorSocias, Maria E.
dc.contributor.authorSisto, Alicia
dc.contributor.authorPerez, Hector
dc.contributor.authorCahn, Pedro
dc.date.accessioned2024-05-23T18:53:34Z
dc.date.available2024-05-23T18:53:34Z
dc.date.issued2010
dc.description.abstractTuberculosis (TB) has been declared a global emergency, increasing approximately 1% each year. There are evidences that TB is being underdiagnosed worldwide1,2. One of the reasons is the failure of healthcare workers to consider TB in the differential diagnosis of patients with respiratory symptoms. Delay in the diagnosis of TB in HIV-infected people in an important contributor to the excess morbidity and mortality 2,3. The main purpose of this prospective study was to define clinical and epidemiological characteristics that can guide physician to the rapid diagnosis of pulmonary TB in HIV patients. During 18 month (10/2004 to 04/2006), all patients attending for unscheduled visits to an Infectious Diseases Division of a public Hospital in Argentina, were asked if they present cough among their symptoms and if so they were invited to participate in the study. Patients, who signed informed consent, filled a questionnaire and their clinical records were evaluated prospectively. Chest X-Rays were classified according to the classification described by Tattevin, et al.4. Epidemiological and clinical data were compared between HIV patients with TB coinfection and those with HIV and other diagnosis. X2 and t-test were used to compare data. During the period studied, 9245 unscheduled visits were recorded, with 286 patients presenting cough. Among the patients with cough, 40 did not sign the consent. Of the remaining who agreed to participated, 35 (13%) presented a TB diagnosis (positive sputum smear and/or positive sputum or blood culture for M. tuberculosis), 211 have a non-TB diagnosis (most of them with PCP –n=51, 24%-, community acquired pneumonia –n=70, 33%-). Twenty three of the TB patients were HIV co-infected. When TB-HIV-coinfected patients were evaluated (Table 1) and compared with HIV-infected patients who have cough but non-TB diagnosis, statistical association with TB was found with: hepatomegaly (p=0.005); splenomegaly (p=0.003); night-sweats (p=0.001); weight-loss of more than 5 kg (p=0.003; duration of symptoms between 15 and 30 days (p=0.03) but not with longer time; elevate alkaline phosphatase (p=0.03); chest X-ray pattern of typical (p=0.0003) or compatible (p=0.013) with TB and previous contact with a patient with TB. We could not find association (p >0.05) with hemoptysis, pulmonary physical examination, previous TB or incarceration, lower educational level, LT CD4 count, HIV-1 viral load, number of previous opportunistic infections or white cell count.
dc.identifier.citationLaufer, N., Sued, O., Abusamra, L., Cabrini, M., Socias, E., Sisto, A., Perez, H., & Cahn, P. (2010). The coughing patient: TB or not TB; that is the question. JAIDS Journal of Acquired Immune Deficiency Syndromes.
dc.identifier.other10.1097/QAI.0b013e3181d54528
dc.identifier.urihttps://repositorio.huesped.org.ar/handle/123456789/1114
dc.relation.ispartofseriesJAIDS Journal of Acquired Immune Deficiency Syndromes
dc.subjectCoughing patient
dc.subjectTB
dc.subjectDifferential Diagnosis
dc.titleThe coughing patient: TB or not TB; That is the question

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