TB or not TB? Difficulties in the diagnosis op tuberculosis in HIV-negative immigrants to Germany

<p>Abstract</p> <p>Background</p> <p>Immigrants to Germany and their children are at particular risk for tuberculosis (TB).</p> <p>Methods</p> <p>35 Patients (10 male/25 female aged 2 - 59 years (median 33 years) originating mostly from high inci...

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Main Authors: Singh DD, Vogel M, Müller-Stöver I, el Scheich T, Winzer M, Göbels S, Hüttig F, Heinrich S, MacKenzie G, Jensen B, Reuter S, Häussinger D, Richter J
Format: Article
Language:English
Published: BMC 2011-09-01
Series:European Journal of Medical Research
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Online Access:http://www.eurjmedres.com/content/16/9/381
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Summary:<p>Abstract</p> <p>Background</p> <p>Immigrants to Germany and their children are at particular risk for tuberculosis (TB).</p> <p>Methods</p> <p>35 Patients (10 male/25 female aged 2 - 59 years (median 33 years) originating mostly from high incidence countries in Asia (19 [54.3%]) in Africa (14 [40.0%] and East Europe (2 [5.7%]), attended at the Tropical Medicine unit were analysed.</p> <p>Results</p> <p>Primary clinical presentation was most frequently lymphadenitis (13 [37.1%]). other organs involved included bones (7 [20.0%]), central nervous system (5 [14.3%]), urogenital organs (3 [8.6%]), lung (3 [8.6%]), mediastinum, (2 [5.7%]) and abdomen (2 [5.7%]). ESR was abnormal in 21/28 (75.0%), CRP in 20/35 (57.1%), and protein electrophoresis in 22/26 (84.6%) cases. The tuberculin skin test was strongly positive in all 15 cases where the test had been performed. Tuberculosis interferon gamma release assay (TB-IGRA) was positive in all 35 cases (100%). PCR for nucleic acids of <it>Mycobacterium (M.) tuberculosis </it>complex was positive in only 7/20 (35.0%) cases. <it>M. tuberculosis </it>was identified in 32/35 (91.4%), <it>M. bovis </it>in 2 (5.7%) cases. 1 case was diagnosed clinically. All patients were negative for HIV. Typical histopathology was seen in the 29 cases, where biopsies had been taken. Chest-X-ray did not reveal specific pulmonary lesions in the majority of cases (22/35 [62.9%]). Diagnosis of TB was mostly delayed (4 to 299 weeks, [median 8]). The most frequent primary suspicion was a malignancy (17/35 [48.6%]) while TB was initially suspected in 5 cases only. Diagnosis of TB is impeded by its multifaceted presentation especially in immigrants.</p>
ISSN:2047-783X