Table 1.
Baseline Clinical Characteristics and Outcomes of the 258 Immunocompromised Patients With Pauci-Bacillary Pulmonary TB
| Missed TB (n = 134) | Not-Missed TB (n = 124) | P Value | |
|---|---|---|---|
| Age, median (IQR), y | 66.0 (56.0–75.0) | 60.5 (50.0–69.0) | .003 |
| Male gender | 99 (74) | 89 (72) | .70 |
| Initial clinical symptom or sign | |||
| Fever or febrile sense | 23 (17) | 24 (19) | .65 |
| Cough or sputum | 24 (18) | 29 (23) | .28 |
| Weight loss | 3 (2) | 6 (5) | .32 |
| Dyspnea | 19 (14) | 17 (14) | .91 |
| Other symptoms | 5 (4) | 3 (2) | .72 |
| Abnormal image of chest x-ray | 72 (54) | 54 (44) | .10 |
| Underlying disease | |||
| HIV | 0/116 (0) | 1/110 (1) | .49 |
| Hematologic malignancy | 12 (9) | 6 (5) | .20 |
| Solid tumor | 102 (76) | 70 (56) | <.001 |
| Bone marrow transplant | 2 (1) | 0 (0) | .499 |
| Solid organ transplant | 8 (6) | 8 (6) | .87 |
| Hemodialysis or peritoneal dialysis | 4 (3) | 6 (5) | .53 |
| Diabetes mellitus | 33 (25) | 33 (27) | .72 |
| Underlying condition | |||
| Neutropenia (ANC < 500/m3) | 4 (3) | 1 (1) | .21 |
| Steroid usea | 12 (9) | 6 (5) | .20 |
| Immunosuppressant useb | 14 (10) | 16 (13) | .54 |
| TNF-alpha blocker | 2 (1) | 5 (4) | .27 |
| Cytotoxic chemotherapy within 1 mo | 30 (22) | 15 (12) | .03 |
| Outpatient clinic | 7 (5) | 11 (9) | .25 |
| Previous history of tuberculosis | 20 (15) | 15 (12) | .51 |
| Previous history of tuberculosis treatment | 18/132 (14) | 13/122 (10) | .57 |
| Types of respiratory specimens | |||
| Expectorated sputum | 105 (78) | 83 (67) | .04 |
| Induced sputum | 9 (7) | 9 (7) | .87 |
| Bronchoalveolar lavage fluid | 20 (15) | 32 (26) | .03 |
| NAAT performed | 60 (45) | 106 (85) | <.001 |
| No. of M. tuberculosis PCRs requested | |||
| 1 | 42 | 67 | <.001 |
| 2 | 14 | 25 | .03 |
| 3 | 2 | 11 | .007 |
| No. of Xpert TB/RIFs requested | |||
| 1 | 3 | 20 | <.001 |
| 2 | 0 | 3 | .07 |
| Positive IGRA results | 4/13c (30) | 15/23c (65) | .047 |
| CT scan performed | 111 (83) | 119 (96) | .001 |
| Patient with concurrent extrapulmonary TB | |||
| Lymph node | 2 (1) | 6 (5) | .12 |
| Pleural | 8 (6) | 12 (10) | .27 |
| Pericardial | 0 (0) | 1 (1) | .48 |
| Intra-abdominal | 0 (0) | 9 (7) | <.001 |
| Genitourinary | 0 (0) | 1 (1) | .48 |
| Skeletal | 1 (1) | 0 (0) | >.99 |
| Central nervous system | 0 (0) | 1 (1) | .48 |
| Bone marrow | 0 (0) | 1 (1) | .48 |
| Disseminated | 3 (2) | 19 (15) | <.001 |
| Drug resistance | |||
| Isoniazid resistance | 10/112 (9) | 6/103 (6) | .39 |
| Rifampin resistance | 1/112 (1) | 2/103 (2) | .61 |
| Multidrug resistance | 2/112 (2) | 2/103 (2) | >.99 |
| Empirical antibiotics use | |||
| FQ use | 41 (31) | 30 (24) | .25 |
| Long-term FQ | 26 (19) | 11 (9) | .02 |
| Short-term FQ | 15 (11) | 19 (15) | .33 |
| Non-FQ use | 40 (30) | 39 (32) | .78 |
| Carbapenem | 7 (5) | 15 (12) | .048 |
| Linezolid | 0 | 0 | — |
| No empirical antibiotic use | 53 (39) | 55 (44) | .43 |
| Interval from mycobacterial test to initiation of anti-tuberculosis treatment, median (IQR), d | 30.0 (24.0–42.0) | 6.0 (1.0–14.0) | <.001 |
| Interval from mycobacterial test to positive results of mycobacterial culture on liquid or solid medium, median (IQR), d | 23.0 (19.0–29.0) | 20.0 (17.0–24.0) | <.001 |
| Interval from mycobacterial test to positive results of mycobacterial culture on liquid medium, median (IQR), d | 22.0 (18.0–26.0) | 20.0 (17.0–23.0) | .008 |
| Interval from mycobacterial test to positive results of mycobacterial culture on solid medium, median (IQR), d | 33.0 (28.0–41.0) | 31.0 (25.0–38.0) | .044 |
| ICU admission | 12 (9) | 12 (10) | .84 |
| Duration of ICU care, median (IQR), d | 9.5 (6.3–17.5) | 9.0 (4.5–71.3) | .98 |
| Outcome | |||
| Interval between death and acquisition of sputum mycobacterial culture, median (IQR), dd | 55.0 (17.0–104.0) | 85.0 (16.0–129.0) | .34 |
| 30-d mortality | 8 (6) | 8 (6) | .87 |
| 90-d mortality | 19 (14) | 13 (10) | .37 |
| 180-d mortality | 27 (20) | 23 (19) | .75 |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: AFB, acid fast bacilli; ANC, absolute neutrophil count; CT, computed tomography; FQ, fluoroquinolone; ICU, intensive care unit; IGRA, IFN-gamma releasing assay; IQR, interquartile range; NAAT, nucleic acid amplification test; PCR, polymerase chain reaction; TB, tuberculosis; TNF, tumor necrosis factor.
aCorticosteroid use is defined as the use of corticosteroids at a mean minimum dose of 0.3 mg/kg/d of prednisolone equivalent for ≥3 weeks.
bTreatment with immunosuppressants (eg, tacrolimus, cyclosporine, sirolimus, azathioprine, or mycophenolate mofetil) during the previous 90 days.
cNumber of patients with a positive test result/number of patients tested.
dPatients who died in the first 180 days.