title: Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies.
abstract: BACKGROUND
  Diseases caused by Mycobacterium tuberculosis (TB) among adult patients with hematological malignancies have rarely been investigated.
  
  
  METHODS
  Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s) in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes.
  
  
  RESULTS
  Fifty-three of 2984 patients (1.78%) were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41). Thirty-eight patients (72%) with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%), pleural effusion (47%) and fibrocalcific lesions (43%) on chest imaging. The 15 (28%) patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03) and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004) compared to those with disease confined to the lungs.
  
  
  CONCLUSIONS
  TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity.
authors: Department of Internal Medicine, Division of Hematology, National TaiwanUniversity Hospital, Taipei, Taiwan.
authors: Chien-Yuan
authors: CY
authors: Chen
authors: Wang-Huei
authors: WH
authors: Sheng
authors: Aristine
authors: A
authors: Cheng
authors: Woei
authors: W
authors: Tsay
authors: Shang-Yi
authors: SY
authors: Huang
authors: Jih-Luh
authors: JL
authors: Tang
authors: Yee-Chun
authors: YC
authors: Chen
authors: Jaun-Yuan
authors: JY
authors: Wang
authors: Hwei-Fang
authors: HF
authors: Tien
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents