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Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis
BACKGROUND: Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the e...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648401/ https://www.ncbi.nlm.nih.gov/pubmed/33160360 http://dx.doi.org/10.1186/s12890-020-01325-1 |
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author | Takasaka, Naoki Seki, Yoshitaka Fujisaki, Ikumi Uchiyama, Shota Matsubayashi, Sachi Sato, Akihito Yamanaka, Yumie Odashima, Kyuto Kazuyori, Taisuke Seki, Aya Takeda, Hiroshi Ishikawa, Takeo Kuwano, Kazuyoshi |
author_facet | Takasaka, Naoki Seki, Yoshitaka Fujisaki, Ikumi Uchiyama, Shota Matsubayashi, Sachi Sato, Akihito Yamanaka, Yumie Odashima, Kyuto Kazuyori, Taisuke Seki, Aya Takeda, Hiroshi Ishikawa, Takeo Kuwano, Kazuyoshi |
author_sort | Takasaka, Naoki |
collection | PubMed |
description | BACKGROUND: Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). METHODS: We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. RESULTS: Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). CONCLUSIONS: This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion. |
format | Online Article Text |
id | pubmed-7648401 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76484012020-11-09 Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis Takasaka, Naoki Seki, Yoshitaka Fujisaki, Ikumi Uchiyama, Shota Matsubayashi, Sachi Sato, Akihito Yamanaka, Yumie Odashima, Kyuto Kazuyori, Taisuke Seki, Aya Takeda, Hiroshi Ishikawa, Takeo Kuwano, Kazuyoshi BMC Pulm Med Research Article BACKGROUND: Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB). METHODS: We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥ 1 based on low attenuation area < − 950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment. RESULTS: Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p < 0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p = 0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p = 0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p < 0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p = 0.015, and 84.21% vs 60.98%; p = 0.021, respectively). CONCLUSIONS: This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion. BioMed Central 2020-11-07 /pmc/articles/PMC7648401/ /pubmed/33160360 http://dx.doi.org/10.1186/s12890-020-01325-1 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Takasaka, Naoki Seki, Yoshitaka Fujisaki, Ikumi Uchiyama, Shota Matsubayashi, Sachi Sato, Akihito Yamanaka, Yumie Odashima, Kyuto Kazuyori, Taisuke Seki, Aya Takeda, Hiroshi Ishikawa, Takeo Kuwano, Kazuyoshi Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title | Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title_full | Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title_fullStr | Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title_full_unstemmed | Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title_short | Impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
title_sort | impact of emphysema on sputum culture conversion in male patients with pulmonary tuberculosis: a retrospective analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648401/ https://www.ncbi.nlm.nih.gov/pubmed/33160360 http://dx.doi.org/10.1186/s12890-020-01325-1 |
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