Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT. Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital. Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study. The most common site of the involvement was pleura (35.6%). The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain at the infected site (48.1%). Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively. Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old. In 67.3% of patients, tuberculosis was suspected at the initial visit. However, tuberculosis was microbiologically proven in only 23.7% of the patients. The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it. Based on our studies, only 11.2% of the patients were confirmed as EPT. So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study.
Adolescent ; Adult ; Aged ; Biopsy ; Female ; Human ; Incidence ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Tuberculosis/*epidemiology/*pathology/radiography ; Tuberculosis, Lymph Node/epidemiology/pathology/radiography ; Tuberculosis, Osteoarticular/epidemiology/pathology/radiography ; Tuberculosis, Pleural/epidemiology/pathology/radiography ; Tuberculosis, Pulmonary/epidemiology/pathology/radiography

Singapore has experienced a rise in the tuberculosis (TB) incidence rate among her local population since 2008, which we believe, is contributed in no small part to a recent increase in community transmission due to delayed diagnosis of infectious pulmonary TB cases. Data from the TB notification registry showed an increase from 2004 to 2008 in the number and proportion of sputum acid-fast bacilli smear-positive pulmonary TB cases with prolonged cough. Two surveys at the TB Control Unit showed that healthcare system delays exceeded patient delay in seeking medical consultation. There is thus an urgent need to heighten TB awareness among the public and the medical community in order to reduce the time taken to diagnose infectious TB cases in Singapore.
Delayed Diagnosis ; Humans ; Incidence ; Infection Control ; methods ; Lung ; diagnostic imaging ; Radiography ; Referral and Consultation ; Singapore ; epidemiology ; Tuberculosis, Pulmonary ; diagnosis ; epidemiology

OBJECTIVE: To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. RESULTS: Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. CONCLUSION: The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.
Adolescent ; *Disease Outbreaks ; Female ; Humans ; Male ; Mass Screening ; Polymorphism, Restriction Fragment Length ; Radiographic Image Interpretation, Computer-Assisted ; *Radiography, Thoracic ; Republic of Korea/epidemiology ; Retrospective Studies ; Schools ; Tuberculosis, Pulmonary/epidemiology/*radiography

We evaluated the effects of previous pulmonary tuberculosis (TB) on the risk of obstructive lung disease. We analyzed population-based, the Second Korea National Health and Nutrition Examination Survey 2001. Participants underwent chest X-rays (CXR) and spirometry, and qualified radiologists interpreted the presence of TB lesion independently. A total of 3,687 underwent acceptable spirometry and CXR. Two hundreds and ninty four subjects had evidence of previous TB on CXR with no subjects having evidence of active disease. Evidence of previous TB on CXR were independently associated with airflow obstruction (adjusted odds ratios [OR] = 2.56 [95% CI 1.84-3.56]) after adjustment for sex, age and smoking history. Previous TB was still a risk factor (adjusted OR = 3.13 [95% CI 1.86-5.29]) with exclusion of ever smokers or subjects with advanced lesion on CXR. Among never-smokers, the proportion of subjects with previous TB on CXR increased as obstructive lung disease became more severe. Previous TB is an independent risk factor for obstructive lung disease, even if the lesion is minimal and TB can be an important cause of obstructive lung disease in never-smokers. Effort on prevention and control of TB is crucial in reduction of obstructive lung disease, especially in countries with more than intermediate burden of TB.
Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Diseases, Obstructive/*etiology ; Male ; Middle Aged ; Odds Ratio ; Questionnaires ; Radiography, Thoracic ; Republic of Korea/epidemiology ; Respiratory Function Tests ; Risk Factors ; Spirometry ; Tuberculosis, Pulmonary/*complications/*epidemiology/pathology ; Young Adult

Objective: Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before Method: We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups. Results: The untreated PTB group had significantly lower clinical pregnancy (31.7% Conclusions Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.
Abortion, Spontaneous/epidemiology* ; Adult ; China/epidemiology* ; Embryo Transfer/statistics & numerical data* ; Female ; Fertilization in Vitro/statistics & numerical data* ; Humans ; Infertility, Female/etiology* ; Live Birth/epidemiology* ; Middle Aged ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology* ; Pregnancy Outcome/epidemiology* ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary/epidemiology* ; Young Adult

Extrapulmonary organ involvement in human immunodefiaency virus (HIV)-infected patients with pulmonary tuberculosis (TB) is reported to be 26%, however, the clinical predictors of extrapulmonary involvement in pulmonary TB patients has not been reported yet. We tried to determine the clinical predictors of presence of extrapulmonary involvement in patients with pulmonary TB. Cross-sectional study was performed including all adult patients with culture-proven pulmonary TB diagnosed between January 1, 2004 and July 30, 2006, at a tertiary referral hospital in South Korea. The presence of extra-pulmonary TB involvement was diagnosed based on bacteriological, pathological, or clinical evidence. Among 320 patients with a culture-proven pulmonary TB, 40 had extrapulmonary involvement. Patients with bilateral lung involvement were more likely to have extrapulmonary involvement, with an adjusted odds ratio (OR) of 4.21 (95% confidence interval [CI], 1.82-9.72), while patients older than 60 yr (adjusted OR, 0.27; 95% CI, 0.08-0.89), patients with cavitary lesions (adjusted OR, 0.37; 95% CI, 0.16-0.84), and with higher levels of serum albumin (adjusted OR, 0.45; 95% CI, 0.25-0.78) had less frequent involvement. Clinicians should be aware of the possibility of extrapulmonary involvement in TB patients with bilateral lung involvement without cavity formation or lower levels of serum albumin.
Adult ; Aged ; Cross-Sectional Studies ; Female ; Humans ; Male ; Medical Records ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Prevalence ; Regression Analysis ; Retrospective Studies ; Serum Albumin/analysis ; Tuberculosis, Pulmonary/*diagnosis/epidemiology/radiography

To identify differences in the clinical, radiologic, and microbiologic features of pulmonary tuberculosis (TB) in the young (<64 yr) and elderly (> or =65 yr), we performed a retrospective analysis of the medical charts and chest radiographs of 207 young and 119 elderly pulmonary TB patients. Hemoptysis and a febrile sense were more frequent in the young, whereas weakness, dyspnea, anorexia, and mental change were more frequent in the elderly. Elderly patients showed higher frequencies of cardiovascular and chronic lung diseases, whereas the young showed a higher proportion of underlying liver disease. In addition, chest radiography showed a significantly higher frequency of mid or lower lung involvement by TB lesions in the elderly (10.6% vs. 22.7%, p<0.05). Lesions were frequently misdiagnosed as pneumonia or lung cancer in the elderly. However, there was no difference between these two groups in terms of sputum acid-fast bacilli positivity. The elderly showed a higher frequency of adverse drug reactions (18.5% vs. 40.7%, p<0.05), and higher TB-related mortality (1.3% vs. 11.1%, p<0.05). In conclusion this study showed that young and elderly pulmonary TB patients have similar microbiologic features; however, the elderly showed higher frequencies of atypical clinical and radiologic presentations, adverse drug reactions, and higher TB-related mortality.
Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/*therapeutic use ; Comparative Study ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Research Support, Non-U.S. Gov't ; Retrospective Studies ; Risk Assessment/*methods ; Risk Factors ; Survival Analysis ; Survival Rate ; Treatment Outcome ; Tuberculosis, Pulmonary/*drug therapy/mortality/*radiography