Diagnostic associations between pleural and pulmonary tuberculosis

Area of Science:

• Infectious Diseases
• Pulmonology
• Epidemiology

Background:

• Tuberculosis (TB) presents in various forms, including pulmonary tuberculosis (PTB), pleural tuberculosis (PLTB), and co-infection (PLPTB).
• Understanding the diagnostic and prognostic differences between these TB forms is crucial for effective patient management.

Purpose of the Study:

• To evaluate diagnostic differences and associations between PLTB, PTB, and PLPTB.
• To compare mortality rates and identify risk factors for each TB presentation.

Main Methods:

• A 6-year population-based study in Houston, Texas, analyzed data from 2226 TB cases.
• Logistic regression modeling was used to assess risk factors and associations.
• Mycobacterium tuberculosis genotyping was performed on available isolates.

Main Results:

• Mortality was highest in PLPTB patients (HR=1.8), followed by PTB (HR=1.0), and PLTB (HR=0.97), adjusted for age and HIV.
• Independent risk factors for PLTB included liver disease history, MTB culture negativity, symptoms <60 days, chest pain, and age >64.
• Symptoms <60 days and HIV seropositivity predicted PLPTB.
• PLTB patients were less likely to be genotypically clustered than PTB patients; PLPTB patients were more likely to be clustered than PTB patients.

Conclusions:

• PLTB presents as a more acute infection with distinct symptoms and fewer symptomatic days.
• PLPTB represents a more severe disease with higher mortality compared to PTB.
• The distinct clinical presentations suggest potentially different biological mechanisms for pleural involvement in PLTB and PLPTB.