Tuberculosis: still overlooked as a cause of community-acquired pneumonia--how not to miss it.
Tuberculosis (TB) is often mistaken for community-acquired pneumonia (CAP). To avoid missing the diagnosis, we recommend that any CAP patient with upper lobe infiltrate, cavitation, miliary pattern, hemoptysis or >1 month of any of cough, fever, malaise,weakness, night sweats, or significant weight loss, should have sputa submitted for Mycobacterium tuberculosis smear and culture. Any CAP patient failing or relapsing after empiric therapy should be investigated for TB. In the presence of HIV with low CD4 count (< or = 200 cells/mL), the presentation may be atypical, and therefore sputa should be submitted for M tuberculosis. Any HIV patient, regardless of CD4 count, with a known history of positive tuberculin skin test, previous TB, or recent exposure to TB, who presents with CAP, should be investigated for TB.
Kunimoto
Dennis
D
Department of Medicine, University of Alberta Hospitals, 2F1 Walter Mackenzie Centre, 8440 112 Sreet, Edmonton, Alberta T6G 2B7, Canada. dennis.kunimoto@ualberta.ca
Long
Richard
R
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology*; D011379:Prognosis; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*