Cryptic Disseminated Tuberculosis: a Secondary Analysis of Previous Hospital-Based Study

BACKGROUND: The main purpose of this study was to describe the demographic and clinical features of cryptic disseminated TB; it was also aimed to shed light on diagnostic test, procedure results, organ involvement, and outcomes of cryptic disseminated TB in patients with confirmed disseminated TB. MATERIALS AND METHODS: We performed a secondary post hoc analysis of collected data from our previous study entitled “Disseminated Tuberculosis among Adult Patients Admitted to Hamad General Hospital, Qatar: A Five-Year Hospital-Based Study” with modified objectives. This study included patients admitted from January 1, 2006 to December 31, 2010. RESULTS: Twenty-three patients were recruited with non-miliary patterns on chest x-ray. Their mean age was 34.4±12.6 years and 15 (65.6%) were males. The mean duration of illness was 46.13±48.4 days and the most common presenting symptom was fever in 20 patients (87%), while 3 (13%) patients had underlying medical conditions with diabetes mellitus 2 (8.7%), being the most common. Bronchoalveolar lavage (BAL) and bronchial wash (BW) fluids were Acid-fast bacilli (AFB) positive in 1/4 (25%) of the cases and culture-positive for Mycobacterium tuberculosis (M. tuberculosis) in 4/4 (100%) of all the cases. Two patients (8.7%) had positive sputum smear, while 18 (78.3%) patients had positive culture for M. tuberculosis. All except one patient completed their treatment in Qatar. One patient died one month after the start of antituberculous treatment. CONCLUSION: Cryptic disseminated TB should be suspected when a patient from TB-endemic countries develops unexplained fever and cough despite normal or non-miliary pattern chest radiograph. Moreover, respiratory specimen cultures should be obtained from these patients, regardless of the symptoms presented and the initial site of the involved organ.