title: Diagnostic delay of pulmonary tuberculosis in patients with acute respiratory distress syndrome associated with aspiration pneumonia: Two case reports and a mini-review from Japan.
abstract: Diagnosing active tuberculosis in elderly patients presents problems due to nonspecific symptoms and complications such as aspiration pneumonia. The current study presents two cases of pulmonary tuberculosis with bilateral pulmonary infiltrates associated with aspiration pneumonia. The two elderly patients developed acute respiratory distress syndrome as a result of aspiration pneumonia. The diagnoses of pulmonary tuberculosis were delayed in both cases, as the patients were diagnosed with active tuberculosis following discharge from hospital. The sputum test for acid-fast bacillus at the time of administration was smear-negative/culture-positive in these patients. They were treated with isoniazid, rifampicin and ethambutol, and nosocomial transmission of tuberculosis from these patients was not reported. The number of elderly patients with aspiration pneumonia is predicted to increase rapidly, and aspiration pneumonia combined with pulmonary tuberculosis is a major medical and healthcare concern in Japan. The present study concludes that physicians should always consider the complication of pulmonary tuberculosis when treating pneumonia patients, in particular in treating elderly patients with pulmonary infiltrates.
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakao
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sone
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kagawa
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Kurokawa
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Kunieda
authors.affiliation: Department of Respiratory Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Yatomi, Aichi 498-8502, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Muramatsu
keywords: acute respiratory distress syndrome; aspiration pneumonia; diagnostic delay; elderly; tuberculosis