Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies

BMC Infectious Diseases

Shan-Chwen Chang¹  Hwei-Fang Tien³  Jaun-Yuan Wang⁴  Yee-Chun Chen¹  Jih-Luh Tang³  Shang-Yi Huang³  Woei Tsay³  Aristine Cheng¹  Wang-Huei Sheng²  Chien-Yuan Chen³ 

[1] Department of Internal Medicine, Division of Infectious disease, National Taiwan University Hospital, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan;Department of Internal Medicine, Division of Hematology, National Taiwan University Hospital, Taipei, Taiwan;Department of Internal Medicine, Division of Chest, National Taiwan University Hospital, Taipei, Taiwan

关键词: Febrile neutropenia;    Hematological malignancy;    Mycobacterium tuberculosis (TB);   

Others  :  1175525
DOI  :  10.1186/1471-2334-11-324

 received in 2011-07-12, accepted in 2011-11-23,  发布年份 2011

【 摘 要 】

Background

Diseases caused by Mycobacterium tuberculosis (TB) among adult patients with hematological malignancies have rarely been investigated.

Methods

Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s) in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes.

Results

Fifty-three of 2984 patients (1.78%) were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41). Thirty-eight patients (72%) with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%), pleural effusion (47%) and fibrocalcific lesions (43%) on chest imaging. The 15 (28%) patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03) and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004) compared to those with disease confined to the lungs.

Conclusions

TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity.

【 授权许可】

   
2011 Chen et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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