Pulmonary tuberculosis presenting as community-acquired pneumonia.
OBJECTIVE
The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP.


METHODS
A prospective study was performed on consecutive non-immunocompromised patients aged 12 years and older, who were hospitalized for CAP.


RESULTS
Of a total of 346 patients hospitalized for CAP, the aetiological agent was identified in 163 patients (47.1%). M. tuberculosis was isolated in 17 patients (4.9%). Multivariate analysis revealed that the following features were significantly associated with culture-positive PTB: duration of symptoms of more than 2 weeks before hospital admission (odds ratio (OR) 25.10; 95% confidence interval (CI) 4.63-136.05; P<0.001), history of night sweats (OR 5.43; 95% CI 1.10-26.79; P=0.038), chest radiograph showing upper lobe involvement (OR 8.23; 95% CI 1.59-42.53; P=0.012) or cavitary infiltrates (OR 19.41; 95% CI 2.94-128.19; P=0.002), total white blood cell count on admission of 12x10(9)/L or less (OR 6.28; 95% CI 1.21-32.52; P=0.029) and lymphopenia (OR 4.73; 95% CI 1.08-20.85; P=0.040).


CONCLUSIONS
Mycobacterium tuberculosis was not an uncommon cause of CAP requiring hospitalization in Malaysia. A longer duration of symptoms, history of night sweats, upper lobe involvement, cavitary infiltrates, lower total white blood cell count and lymphopenia were predictive of PTB.
Liam
Chong-Kin
CK
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. liamck@ummc.edu.my
Pang
Yong-Kek
YK
Poosparajah
Shyamala
S
D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007958:Leukocyte Count; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008231:Lymphopenia / Q000209:etiology / Q000503:physiopathology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity*; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013542:Sweat / Q000502:physiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology