J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 3, Number 6, December 2011, pages 309-318

Characteristics and Outcome of Patients With Dual Pulmonary Tuberculosis and Non-mycobacterial Respiratory Infections

Figure 1. In-hospital survival curves of subjects (black line) and controls (red line) using Kaplan-Meier. P (log rank test) < 0.005.

**Table 1.** Patient Characteristics Comparing Groups of Control and Subject
	Control	Subject	Total	P-value
Data are presented as mean ± SD (range) unless otherwise indicated. NS: non-significant; PTB: pulmonary tuberculosis; COPD: chronic obstructive pulmonary disease; HCV: hepatitis C virus; HIV: human immunodeficiency virus. P-value for comparisons between PTB and dual infections.
Subjects	128	70.3	54	29.7	182	100
Age years	48.4 ± 23.0 (20 - 93)	64.0 ± 23.0 (16 - 89)	53.0 ± 24.0 (16 - 93)	< 0.0001
< 30 years	44	34.4	10	18.5	54	29.7
30-60 years	43	33.6	5	9.3	48	26.4
> 60 years	41	32.0	39	72.2	80	43.9
Male sex	106	79.2	44	77.3	150	78.7	NS
Indigenes	80	62.5	27	50.0	107	58.8	NS
Origin
Geriatric members	40	31.3	25	46.3	65	35.7	NS
Military conscripts	26	20.3	6	11.1	32	17.6	NS
Civilian	62	48.4	23	42.6	85	46.7	NS
Low socioeconomic	71	55.5	40	74.1	111	61.0	0.0187
Comorbidities
Ever-smoker	64	50.0	30	55.6	94	51.6	NS
COPD	28	21.9	13	24.1	41	22.5	NS
Recurrent PTB	27	21.1	8	14.8	35	19.2	NS
Alcoholism	44	34.4	17	31.5	61	33.5	NS
HCV	5	3.9	5	9.3	10	5.5	NS
Cirrhosis	15	11.7	9	16.7	24	13.2	NS
Renal insufficiency	13	10.2	15	27.8	28	15.4	0.0041
Diabetes	13	10.2	7	13.0	20	11.0	NS
Malignancy	5	3.9	6	11.1	11	6.0	NS
HIV	0	0	1	1.9	1	0.5	NS

Table 1. Patient Characteristics Comparing Groups of Control and Subject

Control

Subject

Total

P-value

Data are presented as mean ± SD (range) unless otherwise indicated. NS: non-significant; PTB: pulmonary tuberculosis; COPD: chronic obstructive pulmonary disease; HCV: hepatitis C virus; HIV: human immunodeficiency virus. P-value for comparisons between PTB and dual infections.

Subjects

128

70.3

29.7

182

100

Age years

48.4 ± 23.0 (20 - 93)

64.0 ± 23.0 (16 - 89)

53.0 ± 24.0 (16 - 93)

< 0.0001

< 30 years

34.4

18.5

29.7

30-60 years

33.6

9.3

26.4

> 60 years

32.0

72.2

43.9

Male sex

106

79.2

77.3

150

78.7

Indigenes

62.5

50.0

107

58.8

Origin

Geriatric members

31.3

46.3

35.7

Military conscripts

20.3

11.1

17.6

Civilian

48.4

42.6

46.7

Low socioeconomic

55.5

74.1

111

61.0

0.0187

Comorbidities

Ever-smoker

50.0

55.6

51.6

COPD

21.9

24.1

22.5

Recurrent PTB

21.1

14.8

19.2

Alcoholism

34.4

31.5

33.5

HCV

3.9

9.3

5.5

Cirrhosis

11.7

16.7

13.2

Renal insufficiency

10.2

27.8

15.4

0.0041

Diabetes

10.2

13.0

11.0

Malignancy

3.9

11.1

6.0

HIV

1.9

0.5

**Table 2.** Symptoms, Laboratory and Radiographic Characteristics of Active PTB Patients
	Control	Subject	Total	P-value
Data are presented as mean ± SD and N (%) unless otherwise indicated. NS: non-significant; PTB: pulmonary tuberculosis; WBC: white blood cell counts; Na: sodium; K: potassium; BUN: blood urea nitrogen; AST: aspartate aminotransferase; ALT: alanine aminotransaminase; Gamma-GT: gamma glutamyl transpeptidase.
Clinical symptoms
Fever	68	53.1	23	42.6	91	50.0	NS
Cough/sputum	100	78.1	49	90.7	149	81.9	0.0436
Hemoptysis	13	10.2	7	13.0	20	11.0	NS
Chest pain	18	14.1	6	11.1	24	13.2	NS
Weight loss	24	18.8	7	13.0	31	17.0	NS
Laboratory characteristics
WBC (10³/L)	9.0 ± 4.3	11.7 ± 5.2	9.8 ± 4.7	0.0005
Hemoglobin (g/dL)	12.3 ± 1.8	11.8 ± 2.1	12.2 ± 1.9	NS
Platelet (10³/L)	302.1 ± 134.5	259.0 ± 108.5	288.7 ± 128.2	0.0400
Neutrophil (%)	74.0 ± 11.3	78.4 ± 13.7	75.4 ± 12.2	0.0318
Lymphocyte (%)	16.7 ± 8.8	12.6 ± 8.3	15.4 ± 8.8	0.0059
Na (mmol/L)	134.7 ± 5.2	133.2 ± 7.6	134.3 ± 6.0	NS
K (mmol/L)	4.0 ± 0.6	3.9 ± 0.7	4.0 ± 0.6	NS
BUN (mg/dL)	15.0 ± 8.8	25.3 ± 21.4	18.1 ± 14.6	0.0014
Creatinine (mg/dL)	1.0 ± 0.6	1.2 ± 0.8	1.1 ± 0.6	NS
AST (U/L)	39.0 ± 37.1	52.2 ± 61.5	42.7 ± 45.5	NS
ALT (U/L)	29.1 ± 28.0	50.7 ± 121.0	34.9 ± 67.2	NS
Total bilirubin (mg/dL)	1.1 ± 1.3	1.1 ± 0.9	1.1 ± 1.2	NS
G-GT (U/L)	65.5 ± 103.2	91.2 ± 174.1	72.3 ± 125.7	NS
Alkaline phosphatase (U/L)	93.7 ± 48.3	90.0 ± 47.2	92.3 ± 47.7	NS
Cholesterol (mg/dL)	128.1 ± 39.1	121.1 ± 53.4	126.1 ± 43.5	NS
Triglyceride (mg/dL)	89.6 ± 57.9	85.7 ± 59.6	88.4 ± 58.2	NS
Albumin (mg/dL)	3.1 ± 0.7	2.8 ± 0.8	3.0 ± 0.8	0.0091
Radiographic characteristics
Upper lobe infiltrate	70	54.7	18	33.3	88	48.4	0.0085
Multi-lobar infiltrates	11	8.6	12	22.2	23	12.6	0.0115
Alveolar consolidation	33	25.8	26	48.2	59	32.4	0.0032
Pleural effusion	24	18.8	8	14.8	32	17.6	NS
Cavitary lesion	13	10.2	3	5.6	16	8.8	NS
Bronchiectasis	8	6.3	3	5.6	11	6.0	NS
Emphysema	20	15.6	4	7.4	24	13.2	NS

Table 2. Symptoms, Laboratory and Radiographic Characteristics of Active PTB Patients

Control

Subject

Total

P-value

Data are presented as mean ± SD and N (%) unless otherwise indicated. NS: non-significant; PTB: pulmonary tuberculosis; WBC: white blood cell counts; Na: sodium; K: potassium; BUN: blood urea nitrogen; AST: aspartate aminotransferase; ALT: alanine aminotransaminase; Gamma-GT: gamma glutamyl transpeptidase.

Clinical symptoms

Fever

53.1

42.6

50.0

Cough/sputum

100

78.1

90.7

149

81.9

0.0436

Hemoptysis

10.2

13.0

11.0

Chest pain

14.1

11.1

13.2

Weight loss

18.8

13.0

17.0

Laboratory characteristics

WBC (10³/L)

9.0 ± 4.3

11.7 ± 5.2

9.8 ± 4.7

0.0005

Hemoglobin (g/dL)

12.3 ± 1.8

11.8 ± 2.1

12.2 ± 1.9

Platelet (10³/L)

302.1 ± 134.5

259.0 ± 108.5

288.7 ± 128.2

0.0400

Neutrophil (%)

74.0 ± 11.3

78.4 ± 13.7

75.4 ± 12.2

0.0318

Lymphocyte (%)

16.7 ± 8.8

12.6 ± 8.3

15.4 ± 8.8

0.0059

Na (mmol/L)

134.7 ± 5.2

133.2 ± 7.6

134.3 ± 6.0

K (mmol/L)

4.0 ± 0.6

3.9 ± 0.7

4.0 ± 0.6

BUN (mg/dL)

15.0 ± 8.8

25.3 ± 21.4

18.1 ± 14.6

0.0014

Creatinine (mg/dL)

1.0 ± 0.6

1.2 ± 0.8

1.1 ± 0.6

AST (U/L)

39.0 ± 37.1

52.2 ± 61.5

42.7 ± 45.5

ALT (U/L)

29.1 ± 28.0

50.7 ± 121.0

34.9 ± 67.2

Total bilirubin (mg/dL)

1.1 ± 1.3

1.1 ± 0.9

1.1 ± 1.2

G-GT (U/L)

65.5 ± 103.2

91.2 ± 174.1

72.3 ± 125.7

Alkaline phosphatase (U/L)

93.7 ± 48.3

90.0 ± 47.2

92.3 ± 47.7

Cholesterol (mg/dL)

128.1 ± 39.1

121.1 ± 53.4

126.1 ± 43.5

Triglyceride (mg/dL)

89.6 ± 57.9

85.7 ± 59.6

88.4 ± 58.2

Albumin (mg/dL)

3.1 ± 0.7

2.8 ± 0.8

3.0 ± 0.8

0.0091

Radiographic characteristics

Upper lobe infiltrate

54.7

33.3

48.4

0.0085

Multi-lobar infiltrates

8.6

22.2

12.6

0.0115

Alveolar consolidation

25.8

48.2

32.4

0.0032

Pleural effusion

18.8

14.8

17.6

Cavitary lesion

10.2

5.6

8.8

Bronchiectasis

6.3

5.6

6.0

Emphysema

15.6

7.4

13.2

**Table 3.** Sputum AFB, Delayed Diagnosis of PTB and In-hospital Outcomes of Both Groups
	Control	Subject	Total	P-value
Data are presented as N (%) unless otherwise stated. NS: non-significant; AFB: acid-fast stain; PTB: pulmonary tuberculosis.
Positive sputum AFB	61	47.7	28	51.9	92	50.5	NS
Delayed diagnosis of PTB	37	28.8	25	46.3	62	34.1	0.0271
In-hospital outcomes							0.0436
Nosocomial pneumonia	10	7.8	12	22.2	22	12.1	0.0064
Acute respiratory failure	11	8.6	17	31.5	28	15.4	< 0.0001
Septic shock	4	3.1	8	14.8	12	6.6	0.0069
Mortality	5	3.9	14	25.9	19	10.4	< 0.0001

Table 3. Sputum AFB, Delayed Diagnosis of PTB and In-hospital Outcomes of Both Groups

Control

Subject

Total

P-value

Data are presented as N (%) unless otherwise stated. NS: non-significant; AFB: acid-fast stain; PTB: pulmonary tuberculosis.

Positive sputum AFB

47.7

51.9

50.5

Delayed diagnosis of PTB

28.8

46.3

34.1

0.0271

In-hospital outcomes

0.0436

Nosocomial pneumonia

7.8

22.2

12.1

0.0064

Acute respiratory failure

8.6

31.5

15.4

< 0.0001

Septic shock

3.1

14.8

6.6

0.0069

Mortality

3.9

25.9

10.4

< 0.0001

**Table 4.** Bacterial Species and the Associated Number of the Subjects
Bacterial species	Number (N)
Atypical pathogens
Mycoplasma pneumonia	12
Legionella pneumonia	6
Chlamydia pneumnia	2
Gram-positive pathogens
Steptococcus pneumonia	6
Staphylococcus aureus	6
Enterococcus species	1
Gram-negative pathogens
Klebsiella pneumoniae	11
Haemophilus influenzae	6
Pseudomonas aeruginosa	4
Escherichia coli	4
Proteus mirabilis	3
Stenotrophomonas maltophilia	3
Enterobacter	2

Table 4. Bacterial Species and the Associated Number of the Subjects

Bacterial species

Number (N)

Atypical pathogens

Mycoplasma pneumonia

Legionella pneumonia

Chlamydia pneumnia

Gram-positive pathogens

Steptococcus pneumonia

Staphylococcus aureus

Enterococcus species

Gram-negative pathogens

Klebsiella pneumoniae

Haemophilus influenzae

Pseudomonas aeruginosa

Escherichia coli

Proteus mirabilis

Stenotrophomonas maltophilia

Enterobacter

**Table 5.** Microbiological Characteristics and the Prognosis in Patients With Dual Infections
	Survivors	Deceased	Total	P-value
Data are presented as N (%) unless otherwise stated. NS: non-significant; TB: tuberculosis.
Bacteriological classifications							NS
Atypical bacteria	14	70.0	6	30.0	20	30.3
Gram-positive bacteria	9	69.2	4	30.8	13	19.7
Gram-negative bacteria	23	69.7	10	30.2	33	50.0
Number of non-TB bacterial infections							0.0147
Poly-bacterial infection	13	56.5	10	43.5	23	42.6
Mono-bacterial infection	27	87.1	4	12.9	31	57.4

Table 5. Microbiological Characteristics and the Prognosis in Patients With Dual Infections

Survivors

Deceased

Total

P-value

Data are presented as N (%) unless otherwise stated. NS: non-significant; TB: tuberculosis.

Bacteriological classifications

Atypical bacteria

70.0

30.0

30.3

Gram-positive bacteria

69.2

30.8

19.7

Gram-negative bacteria

69.7

30.2

50.0

Number of non-TB bacterial infections

0.0147

Poly-bacterial infection

56.5

43.5

42.6

Mono-bacterial infection

87.1

12.9

57.4