To analyze the incidence, clinical, radiological features and treatment outcomes of CNTB (pulmonary and extra pulmonary cases).
A retrospective analysis of 106 patients from 2000–2002 who were given a course of antituberculous medications (minimum of 4 months) was done. CNTB patients were identified as patients who were smear and culture negative but treated for Mycobacterium tuberculosis (TB) because of history, clinical features, radiological features, histopathological features and improvement on antiTB therapy.
Of 106 patients who were treated, 16(15%) were noted to have CNTB. The age of patients with CNTB was 42±25 years and there were 10 males and 6 females. Symptoms of patients having CNTB were as follows: fever 12/16(75%), chronic cough 10/16(62%), weight loss 6/16(50%), hemoptysis 3/16(18%), shortness of breath 3/16(18%), chronic diarrhea 1/16(6%). All 16 patients were PPD +(100%). HIV testing was done in 10(62%) and 2/10 were positive. 6/16(37%) patients had lung involvement –5 with upper lobe infiltrate and 1 with endobronchial granuloma. All 6 underwent bronchoscopy with BAL negative for TB. 4/16(25%) patients had pleural effusions with pleural biopsy suggestive of caseating granulomas. 3/16(18%) patients had lymphadenitis suggestive of TB on histopathology. 1/16(6%) patient had disseminated disease with liver biopsy showing caseating granulomas, 1/16(6%) patient had ileocecal disease suggestive of TB by biopsy and 1/16(6%) patient had chronic prostatitis with prostate biopsy showing caseating granuloma. INH+rifampicin+ethambutol+pyrazinamide for 2 months followed by INH+rifampicin for 4 months was used in all the patients and all improved clinically with no adverse reactions.
Culture negative disease is not an infrequent manifestation of tuberculosis. Clinical, radiological presentation and response to treatment were similar to culture positive disease.
In patients clinically suspected to have TB disease, treatment should be continued and completed inspite of negative cultures.
K. Kanagarajan, None.