Abstract
ObjectivesThe aim of this study is to investigate clinical features of atypical pulmonary tuberculosis (aPTB) mimicking bacterial pneumonia, determine imaging features with the highest degree of correlation, and identify predictors for acid-fast bacilli (AFB) positivity.MethodsThe clinical data of 259 patients considered as aPTB were retrospectively analyzed. The correlation of CT patterns was evaluated with Spearman analysis, and the predictors for AFB positivity were assessed with the multivariate analysis.ResultsThe most common symptom of aPTB was cough (84.6%), followed by fever and anorexia (47.1 and 41.7%, respectively). Infiltrated patchy was the most common radiological pattern (84.9%), followed by nodules (3–10 mm), micronodules (<3 mm), and consolidation (79.2, 78.8, and 66.0%, respectively). Nodules (3–10 mm) and micronodules (r = 0.988, p < 0.001), consolidation and air bronchogram (r = 0.590, p < 0.001), and pulmonary atelectasis and consolidation (r = 0.323, p < 0.001) showed high correlation. In the multivariate analysis, hyperpyrexia (OR, 2.29; 95% CI, 1.22–4.29) and bronchiectasis (OR, 2.06; 95% CI, 1.04–4.06) were the predictors of AFB-smear positivity, while bulla (OR, 0.22; 95% CI, 0.05–0.97) was the predictor of AFB-smear negativity.ConclusionThis study demonstrated the clinical and radiological features of aPTB mimicking pneumonia. Several paired radiological findings may guide us to the diagnosis of aPTB. Hyperpyrexia and bronchiectasis may be helpful for predicting AFB positivity, and bulla may be a predictive sign of AFB negativity.
Highlights
Pulmonary tuberculosis (PTB) is an infectious disease caused by Mycobacterium tuberculosis, remaining one of the top 10 leading threatening agents of death worldwide, especially in the underdeveloped countries and districts [1], which leads to overwhelming economic burden and persistent public health concern
PTB is a common cause of community-acquired pneumonia (CAP), and differential diagnosis between bacterial pneumonia and atypical PTB remains a great challenge for clinical physicians [3,5,6]
Matsuura and Yamaji reported a case with consolidation and multicavity lesions in chest radiography, which was diagnosed as bacterial pneumonia initially but confirmed as PTB by acid-fast bacilli (AFB) smear and polymerase chain reaction test after the failure
Summary
Pulmonary tuberculosis (PTB) is an infectious disease caused by Mycobacterium tuberculosis, remaining one of the top 10 leading threatening agents of death worldwide, especially in the underdeveloped countries and districts [1], which leads to overwhelming economic burden and persistent public health concern. Some PTB patients presented with atypical symptoms and atypical chest images and have been mistaken for bacterial pneumonia when admission [3], leading to the delayed diagnosis and isolation of PTB patients [4]. Kang et al showed the clinical characteristics of 57 bacterial CAP patients and 30 PTB patients and found that compared with bacterial CAP patients, PTB patients presented a higher proportion of cavitary lesions and upper lobe dominance in CT images [9]. Matsuura and Yamaji reported a case with consolidation and multicavity lesions in chest radiography, which was diagnosed as bacterial pneumonia initially but confirmed as PTB by AFB smear and polymerase chain reaction test after the failure
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