TB or not TB? Difficulties in the diagnosis of tuberculosis in HIV-negative immigrants to Germany.
BACKGROUND
Immigrants to Germany and their children are at particular risk for tuberculosis (TB). -


METHODS
35 Patients (10 male / 25 female aged 2 - 59 years (median 33 years) originating mostly from high incidence countries in Asia (19 (54.3%)) in Africa (14 (40.0%) and East Europe (2 (5.7%)), attended at the Tropical Medicine Unit were analysed. -


RESULTS
Primary clinical presentation was most frequently lymphadenitis (13 (37.1%)). Other organs involved included bones (7 (20.0%)), central nervous system (5 (14.3%)), urogenital organs (3 (8.6%)), lung (3 (8.6%)), mediastinum, (2 (5.7%)) and abdomen (2 (5.7%)). ESR was abnormal in 21/28 (75.0%), CRP in 20/35 (57.1%), and protein electrophoresis in 22/26 (84.6%) cases. The tuberculin skin test was strongly positive in all 15 cases where the test had been performed. Tuberculosis interferon gamma release assay (TB-IGRA) was positive in all 35 cases (100%). PCR for nucleic acids of Mycobacterium (M.) tuberculosis complex was positive in only 7/20 (35.0%) cases. M. tuberculosis was identified in 32/35 (91.4%), M. bovis in 2 (5.7%) cases. 1 case was diagnosed clinically. All patients were negative for HIV. Typical histopathology was seen in the 29 cases, where biopsies had been taken. Chest-X-ray did not reveal specific pulmonary lesions in the majority of cases (22/35 (62.9%)). Diagnosis of TB was mostly delayed (4 to 299 weeks, (median 8)). The most frequent primary suspicion was a malignancy (17/35 (48.6%)) while TB was initially suspected in 5 cases only. Diagnosis of TB is impeded by its multifaceted presentation especially in immigrants.
Tropenmedizinische Ambulanz, Universitätsklinikum Düsseldorf, Moorenstr. 5, Düsseldorf, Germany.
D D
DD
Singh
M
M
Vogel
I
I
Müller-Stöver
T
T
El Scheich
M
M
Winzer
S
S
Göbels
F
F
Hüttig
S
S
Heinrich
C
C
Mackenzie
B
B
Jensen
S
S
Reuter
D
D
Häussinger
Joachim
J
Richter
D000293:Adolescent; D000328:Adult; D000349:Africa; D001208:Asia; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D005060:Europe; D005260:Female; D005858:Germany; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009163:Mycobacterium bovis / Q000235:genetics / Q000302:isolation & purification*; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D060888:Real-Time Polymerase Chain Reaction; D015996:Survival Rate; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult