title: Clinical and Radiographic Manifestations of Sputum Culture-Negative Pulmonary Tuberculosis.
abstract: Intervention at the earliest possible stage of pulmonary tuberculosis (PTB) reduces morbidity for the individual and transmission for the community. We characterize the clinical and radiographic manifestations of sputum culture-negative (Cx-) PTB in order to facilitate awareness of this under recognized and likely early disease state. In this cross-sectional sub-study, we reviewed the medical records of HIV-uninfected PTB patients enrolled from 2006-2014 within the context of a TB biomarker study in New York City. Cx- PTB was defined as clinical and/or radiographic presentation consistent with PTB, three initial mycobacterial sputum cultures negative, and no evidence of other respiratory disease. Diagnosis was confirmed by clinical and radiographic improvement on antituberculous treatment and/or culture, nucleic acid, or histological confirmation from a specimen other than the initial three sputa. Cx+ PTB was defined as above but with M. tuberculosis growth in at least one of the first three sputum cultures. Demographics, symptoms, and radiographic findings on initial presentation were compared between the two groups. Of 99 subjects diagnosed with PTB, 21 met the criteria of Cx- PTB. Cx- compared to Cx+ subjects presented with a significantly lower frequency of cough (70% vs. 91%, P = 0.02), sputum production (30% vs. 64%, P < 0.01), weight loss (25% vs. 54%, P = 0.02), and frequency of cavitation on chest CT (12% vs. 68%, P < 0.01). Our findings should raise awareness that neither a positive culture nor the hallmark symptoms are invariably associated with early TB disease.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Minh-Vu H
authors.initials: MV
authors.lastname: Nguyen
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Jenny-Avital
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Susanne
authors.initials: S
authors.lastname: Burger
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Leibert
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America; Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Achkar
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D011859:Radiography; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000382:microbiology