title: Pulmonary disease empirically treated as tuberculosis-a retrospective study of 107 cases.
abstract: Pulmonary disease is sometimes treated empirically as tuberculosis (TB) in the absence of microbial confirmation if the clinical suspicion of active TB is high. In a country of relatively high TB and low HIV burden, we retrospectively studied 107 patients (69.2% male; mean age (SD): 45 (17) years) who received empirical anti-TB treatment for intrapulmonary opacities or pleural effusions suspected of active TB in our hospitals between 1998 and 2002. The diagnosis of definite or probable 'smear-negative' pulmonary TB was made based on treatment outcome at two months with rifampicin, isoniazid, pyrazinamide and ethambutol (or streptomycin). At this end-point, 81 patients (84.4%) had both clinical and radiological improvement (definite cases), 12 (12.5%) had clinical improvement alone and 3 (3.1%) had radiological improvement alone (probable cases). Confirmation of acid-fast bacilli was subsequently obtained in 12 patients (all definite cases) from culture of initial pulmonary specimens. Eleven patients (10.5%) were diagnosed as 'non-TB' based on absence of both clinical and radiological improvement or discovery of another cause for the pulmonary condition at or before this two-month study end-point. In the 'non-TB' group, 2 had carcinoma, 2 had HIV-related pulmonary diseases, 1 had bronchiectasis, while in 6 causes were indeterminate. Six (6.3%) and 3 (27.3%) patients reported adverse effects from anti-TB drugs from the 'TB' and 'non-TB' groups respectively. Our findings suggest that empirical anti-TB treatment is an acceptable practice if clinical suspicion is high in patients coming in our region.
authors.affiliation: IMU Lung Research, International Medical University, Kuala Lumpur.
authors.forename: L C
authors.initials: LC
authors.lastname: Loh
authors.forename: S Z
authors.initials: SZ
authors.lastname: Abdul Samah
authors.forename: A
authors.initials: A
authors.lastname: Zainudin
authors.forename: G L S
authors.initials: GL
authors.lastname: Wong
authors.forename: W H
authors.initials: WH
authors.lastname: Gan
authors.forename: W S
authors.initials: WS
authors.lastname: Yusuf
authors.forename: P
authors.initials: P
authors.lastname: Vijayasingham
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
chemical_list: D000995:Antitubercular Agents