Characteristics and Outcome of Patients With Dual Pulmonary Tuberculosis and Non-mycobacterial Respiratory Infections

BACKGROUND: Mixed tuberculosis (TB) and bacterial respiratory infections are usually seen in areas where there is an HIV epidemic. However, there have been no previous reports regarding TB patients with concomitant bacterial respiratory infections in a non-HIV prevalent region. This study was to evaluate the clinical characteristics and outcomes of patients with dual TB and bacterial respiratory infections in Hualien, Taiwan. METHODS: A retrospective cohort study was conducted in a community teaching hospital in Hualien from 2000 to 2007. Those who fulfilled the criteria for active pulmonary tuberculosis (PTB) were included and divided into subjects with concomitant bacterial infections and controls. Their basic data, clinical presentations and in-hospital outcomes were reviewed and analyzed. RESULTS: During 2000 - 2007, a total of 182 patients were diagnosed as having PTB. Of them, 54 (29.7%) had dual infections. Comorbidities were common in these patients. Older age and lower socioeconomic status were present in subjects than in controls. In terms of disease characteristics, symptoms of cough and sputum production, laboratory findings of leukocytosis with left shift, thrombocytopenia, renal insufficiency and lower serum albumin level, as well as radiographic patterns of multi-lobar infiltrates and alveolar consolidations prevailed amongst subjects (P < 0.05). Delayed diagnosis in PTB and increased rates of in-hospital morbidity and mortality associated with polymicrobial infections were noted in subjects with dual infections. CONCLUSIONS: In a non-HIV prevalent area, patients of older age, lacking access to good health care, and suffering from malnutrition were predisposed to dual infections and had poor prognosis and outcomes. KEYWORDS: Pulmonary tuberculosis; Dual nontuberculous bacterial respiratory infections