Despite the requirement of bacteriological confirmation in diagnosing tuberculosis (TB), the report to the local department of health (DOH) of clinically diagnosed, culture negative tuberculosis (CNTB) cases has increased in the last decade. Of the total reported cases in New York City in 2001, 23.6% were CNTB versus 9.7% in 1992. Among patients diagnosed with TB at Harlem Hospital, 28.6% were CNTB. Our aim was to review the CNTB cases reported at this hospital to assess the validity of its diagnostic criteria.
Retrospective chart and radiological review of TB cases at Harlem Hospital from 1999 to 2003 reported to the DOH
In this period, 98 TB cases were reported with 66(67.3%) males, 32(32.6%) females; 85(86.7%) Blacks, 9(1%) Latinos. Fifty (51%) were foreigners, 46(47%) US born and 2(2%) unknown. Thirty-six(36.7%) were HIV-positive, 46(46.9%) HIV-negative and 16(16.3%) unknown. Site of disease was pulmonary only in: 53(54%), extrapulmonary 23(23.46%) and both in 22(22.44%). Seventy patients (71.5%) had bacteriological confirmation; 26/98(26.5%) had tissue diagnosis. Twenty-eight patients (28.5%), were CNTB. Of these 8(28.6%) had pulmonary TB, 14(50%) extrapulmonary TB and 6(21.4%) both; with 9/28 (32.2%) HIV-positive. Treatment was completed in 27/28 (96.5%) and 1 patient died. Pathology supported the diagnosis in 18/28 (64.5%) patients with CNTB, 2 cases were diagnosed with nuclear amplification assay test alone. Twenty-three(82%) patients met the criteria for clinical diagnosis (positive tuberculin skin test, clinical/radiological evidence of TB, and response to anti-TB drugs). Five patients (18%) did not fulfill all of the above criteria (provider diagnosis).CONCLUSIONS: An increase in the proportion of CNTB has been noted at our institution and the local DOH. Review of our cases demonstrated that appropriate work up was conducted and that the majority fulfilled established criteria for clinical TB diagnosis. High index of suspicion is needed, especially in immune-suppressed and pediatric populations.
High index of suspicion is of value in treating patients with mycobacterium TB infection when cultures are negative or not available
J. Salazar-Schicchi, None.