Comparison of clinical characteristics between nontuberculous mycobacterial pulmonary disease and pulmo-nary tuberculosis in AIDS patients

Abstract

Objective To improve the diagnositic level of nontuberculous mycobacterial (NTM) pulmonary disease and pulmonary tuberculosis (TB) in AIDS patients. Methods The medical records of 48 AIDS patients with NTM pulmonary disease (NTM group) and 60 AIDS patients with TB (TB group) were retrospectively studied, who were diagnosed by bronchoalveolar lavage fluid (BALF) culture in Guangzhou No.8 People's Hospital from January 2009 to December 2015. Results The majority of patients in NTM group and TB group were young and middle-aged men. The common clinical manifestations such as fever, cough, expectoration and marasmus in two groups were similar (P all> 0.05) . However, the incidence of afternoon fever in NTM group was less than that in TB group (47.9% vs 68.3%, χ2=4.604, P 0.05) , but the positive rates of acid fast staining for sputum and BALF in NTM group were significantly lower than those in TB group (6.3% vs 20.0%, χ2=4.251; 12.5% vs 43.3%, χ2=12.159; P all<0.05) . The CT imaging features of chest and abdomen showed that the upper lobe involvement was less common in NTM group than in TB group (54.2% vs 91.7%) , and the incidences of miliary lesions, thoracic lymphadenopathy, pleural effusion and pericardial effusion were less frequent in NTM group than those in TB group (14.6% vs 31.7%, χ2=4.258; 66.7% vs 86.7%, χ2=6.171; 25.0% vs 43.3%, χ2=3.930; 6.3% vs 21.7%, χ2=5.022; P all<0.05) . Moreover, the enlarged lymph nodes were mainly located in the mediastina in NTM group (43.8%) but around the hilus of lung in TB group (53.3%) . Conclusions The clinical manifestations and laboratory indices of NTM pulmonary disease are similar to TB in AIDS patients, and the chest imaging can be valuable for differential diagnosis. Key words: Acquired immune deficiency syndrome; Pulmonary tuberculosis; Nontuberculous mycobacterialpulmonary disease; Differential diagnosis; Chest imaging