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Original Research: INFECTION |

Unexpected Pulmonary Involvement in Extrapulmonary Tuberculosis Patients

Tanyalak Parimon, MD; Christopher E. Spitters, MD, MPH; Nisa Muangman, MD; Juntima Euathrongchit, MD; Eyal Oren, MSc; Masahiro Narita, MD
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Drs. Parimon and Narita), and the Department of Radiology (Drs. Muangman and Euathrongchit), University of Washington; and the TB Control Program (Dr. Spitters and Mr. Oren), Public Health–Seattle & King County, Seattle, WA.

Correspondence to: Masahiro Narita, MD, Tuberculosis Control Program, Harborview Medical Center, 325 Ninth Ave, Campus Box 359776, Seattle, WA 98104; e-mail: masa.narita@kingcounty.gov


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3):589-594. doi:10.1378/chest.08-0319
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Background:  This study aimed to assess the utility of sputum examinations and chest radiographs (CXRs) in patients with extrapulmonary tuberculosis (XPTB) to detect pulmonary involvement of tuberculosis (TB).

Methods:  We studied 72 XPTB patients who were managed through the TB Program, King County, WA, from January 2003 through November 2004.

Results:  The two most common sites of XPTB were the lymph nodes (36 [50%]) and pleura (12 [17%]). Thirty-five of 72 XPTB patients (49%) had abnormal CXR findings. Sputum was not obtained from 15 patients despite sputum induction. Of the 57 patients from whom sputum was collected, 30 (53%) had abnormal CXR findings, 5 (9%) had sputum smears that were positive for acid-fast bacilli, and 12 (21%) had sputum cultures that were positive for Mycobacterium tuberculosis. Weight loss was significantly associated with positive sputum culture findings in a multivariate analysis (odds ratio, 4.3; 95% confidence interval, 1.01 to 18.72; p = 0.049). There was no significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings and those with normal CXR findings (7 of 30 patients [23%] vs 5 of 27 patients [19%], respectively; p = 0.656). Of 24 HIV-negative XPTB patients with normal CXR findings, 2 patients (8%) had positive sputum culture findings.

Conclusions:  CXR results did not reliably differentiate XPTB patients with and without positive sputum culture findings. Some XPTB patients had positive sputum culture results despite normal CXR findings and negative HIV status. Weight loss in XPTB patients was associated with positive sputum culture results. Sputum examinations in XPTB patients, regardless of the CXR results, may identify potentially infectious cases of TB.


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