Clinical characteristic differences between pulmonary melioidosis and pulmonary tuberculosis with cavitary lesion

Abstract

<b>Background:</b> The common infectious etiology of cavitary lung lesion is pulmonary tuberculosis, especially in countries with high prevalence of tuberculosis as Vietnam where melioidosis, another condition causing cavitary lung lesion is also highly prevalent. <b>Objectives:</b> To identify specific characteristics differentiating pulmonary melioidosis from tuberculosis in patients with cavitary lung lesion. <b>Methods:</b> We conducted a study with matched sampling methods at the respiratory department of a large tertiary hospital from 2018 to 2020 in Ho Chi Minh City. A patient with pulmonary melioidosis was matched with another patient with pulmonary tuberculosis, both having cavitary lesions and the same sex and age. <b>Results:</b> We found 11 subjects, 2 females and 9 males, mean age 51.27 (± 0.66), with pulmonary melioidosis and cavitary lesions. 10 subjects had diabetes mellitus and one had history of alcohol abuse. Comparing to pulmonary tuberculosis with cavitary lesions, subjects with pulmonary melioidosis had fever more frequently (p &lt; 0.01), higher neutrophil-lymphocyte ratio (p = 0.039, median ratio 14.05 vs 2.66), higher level of C-reactive protein (p = 0.028, median level 147.40 vs 54.80 mg/L), and showed more severe hyponatremia at the time of admission (p = 0.001, median Na 126 vs 132 mmol/L). <b>Conclusion:</b> Patients with pulmonary melioidosis and cavitary lesions had more severe bacterial infection characteristics such as fever, high levels of C-reactive protein, high neutrophil-lymphocyte ratios and hyponatremia as compared with patients with tuberculosis.