Effect of immunosuppressive therapy on the clinical presentation and outcome of tuberculosis.

A total of 177 tuberculosis cases of individuals not infected with human immunodeficiency virus diagnosed during the years 1984-1990 at the Helsinki University Central Hospital were reviewed retrospectively to compare the clinical presentation of tuberculosis in patients immunocompromised because of treatment (n = 35) with patients with other underlying conditions (n = 60) and with those without known predisposing factors (n = 82). In immunosuppressed patients compared with other patients, tuberculosis was more frequently disseminated (40% vs. 12%, P < 0.001), lung infiltrations were more often miliary (44% vs. 13%, P < 0.001), and the sputum smears were less often positive (30% vs. 62%, P < 0.05). In addition, the age-adjusted odds ratio for the risk of dying was higher among immunosuppressed patients than among the two other groups. The low rate of positive sputum smears and the high rate of atypical presentation and mortality stress the importance of a high index of suspicion and early institution of empirical antituberculosis therapy in immunosuppressed patients.

[1]  P. Hopewell.  Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and control of tuberculosis. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  D. Snider,et al.  Tuberculosis diagnosed at death in the United States. , 1991, Chest.

[3]  W. R. Mccabe,et al.  Bacteremia Due to Mycobacterium tuberculosis in Patients with Human Immunodeficiency Virus Infection: A Report of 9 Cases and a Review of the Literature , 1990, Medicine.

[4]  M. Al-Sibai,et al.  Mycobacterial infection after renal transplantation--report of 14 cases and review of the literature. , 1990, The Quarterly journal of medicine.

[5]  R. Chaisson,et al.  Human immunodeficiency virus infection in tuberculosis patients. , 1990, The Journal of infectious diseases.

[6]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[7]  W. Lam,et al.  High incidence of pulmonary tuberculosis in the non-HIV infected immunocompromised patients in Hong Kong. , 1989, Chest.

[8]  P. Barnes,et al.  Chest roentgenogram in pulmonary tuberculosis. New data on an old test. , 1988, Chest.

[9]  R. Kerman,et al.  Comparison of biopsy-proven Pneumocystis carinii pneumonia in acquired immune deficiency syndrome patients and renal allograft recipients. , 1984, The Annals of thoracic surgery.

[10]  J. Shelhamer,et al.  Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. , 1984, Annals of internal medicine.

[11]  B. Dautzenberg,et al.  The management of thirty immunocompromised patients with tuberculosis. , 1984, The American review of respiratory disease.

[12]  D. Hosmer,et al.  Estimating odds ratios with categorically scaled covariates in multiple logistic regression analysis. , 1984, American journal of epidemiology.

[13]  W. R. Mccabe,et al.  Extrapulmonary Tuberculosis Revisited: A Review of Experience at Boston City and Other Hospitals , 1984, Medicine.

[14]  R. Macgregor,et al.  Mycobacterial infections in renal transplant recipients: report of five cases and review of the literature. , 1983, Reviews of infectious diseases.

[15]  N. Horne,et al.  TUBERCULOSIS IN IMMUNOSUPPESSED PATIENTS , 1979, The Lancet.

[16]  J. Marr,et al.  A comparative study of tuberculous and other mycobacterial infections and their associations with malignancy. , 1978, The American review of respiratory disease.

[17]  R. Feld,et al.  Mycobacteriosis in patients with malignant disease. , 1976, Archives of internal medicine.

[18]  D. Armstrong,et al.  Tuberculosis complicating neoplastic disease. A review of 201 cases , 1974, Cancer.