TB or not TB? Difficulties in the diagnosis of tuberculosis in HIV-negative immigrants to Germany

European Journal of Medical Research

J Richter⁴  D Häussinger⁴  S Reuter⁴  B Jensen⁴  G MacKenzie³  S Heinrich²  F Hüttig⁴  S Göbels⁴  M Winzer⁴  T el Scheich²  I Müller-Stöver⁴  M Vogel²  DD Singh¹ 

[1] University Hospital for Maxillofacial Surgery;University Hospital for Pediatrics;Institute for Medical Microbiology und Hospital Hygiene, Faculty of Medicine, Heinrich-Heine-university, Düsseldorf, Germany;University Hospital for Gastroenterology, Hepatology und Infectious Diseases

关键词: TBC-IGRA;    tuberculin skin test;    diagnostics;    neoplasia;    lymphoma;    children;    migrants;    M. bovis;    M. tuberculosis;    Mycobacterium;    Tuberculosis;   

Others  :  824882
DOI  :  10.1186/2047-783X-16-9-381

 received in 2011-04-20, accepted in 2011-05-26,  发布年份 2011

【 摘 要 】

Background

Immigrants to Germany and their children are at particular risk for tuberculosis (TB).

Methods

35 Patients (10 male/25 female aged 2 - 59 years (median 33 years) originating mostly from high incidence countries in Asia (19 [54.3%]) in Africa (14 [40.0%] and East Europe (2 [5.7%]), attended at the Tropical Medicine unit were analysed.

Results

Primary clinical presentation was most frequently lymphadenitis (13 [37.1%]). other organs involved included bones (7 [20.0%]), central nervous system (5 [14.3%]), urogenital organs (3 [8.6%]), lung (3 [8.6%]), mediastinum, (2 [5.7%]) and abdomen (2 [5.7%]). ESR was abnormal in 21/28 (75.0%), CRP in 20/35 (57.1%), and protein electrophoresis in 22/26 (84.6%) cases. The tuberculin skin test was strongly positive in all 15 cases where the test had been performed. Tuberculosis interferon gamma release assay (TB-IGRA) was positive in all 35 cases (100%). PCR for nucleic acids of Mycobacterium (M.) tuberculosis complex was positive in only 7/20 (35.0%) cases. M. tuberculosis was identified in 32/35 (91.4%), M. bovis in 2 (5.7%) cases. 1 case was diagnosed clinically. All patients were negative for HIV. Typical histopathology was seen in the 29 cases, where biopsies had been taken. Chest-X-ray did not reveal specific pulmonary lesions in the majority of cases (22/35 [62.9%]). Diagnosis of TB was mostly delayed (4 to 299 weeks, [median 8]). The most frequent primary suspicion was a malignancy (17/35 [48.6%]) while TB was initially suspected in 5 cases only. Diagnosis of TB is impeded by its multifaceted presentation especially in immigrants.

【 授权许可】

   
2011 I. Holzapfel Publishers

【 图 表 】

Figure 1.

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