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Unexpected Pulmonary Involvement in Extrapulmonary Tuberculosis Patients

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA ² Departments of Radiology, University of Washington, Seattle, WA ³ TB Control Program, Public Health - Seattle & King County, Seattle, WA

masa.narita{at}kingcounty.gov

Abstract

BackgroundThis study aimed to assess the utility of sputum examinations and chest radiographs (CXRs) in patients with extrapulmonary tuberculosis (XPTB) to detect pulmonary involvement of tuberculosis (TB).

MethodsWe studied 72 XPTB patients managed through the TB Program, King County, Washington, from January, 2003 through November, 2004.

ResultsThe two most common sites of XPTB were TB lymphadenitis (36 [50%]) and TB pleuritis (12 [17%]). Abnormal CXRs were found in 35 (49%) of 72 XPTB patients. Sputum was not obtained from 15 patients despite sputum induction. Of 57 patients with sputum collected, 30 (53%) had abnormal CXRs, 5 (9%) had sputum AFB smear positive, and 12 (21%) were sputum culture positive for M. tuberculosis. Weight loss was significantly associated with positive sputum culture in multivariate analysis (odds ratio; 4.3 [1.01-18.72] p=0.049). There was no significant difference in occurrence of positive sputum cultures between patients with abnormal CXR and those with normal CXRs (7 of 30 [23%] vs 5 of 27 [19%], respectively, p=0.656). Of 24 HIV-negative XPTB patients with normal CXRs, two (8%) were sputum culture-positive.

ConclusionsCXR results did not reliably differentiate XPTB cases with vs. without positive sputum cultures. Some XPTB patients had positive sputum culture despite normal CXR findings and negative HIV status. Weight loss in XPTB patients was associated with positive sputum culture. Sputum examination in XPTB patients, regardless of CXR results, may identify potentially infectious TB cases.

Key Words: Tuberculosis • Sputum • Chest film