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Tubercular and bacterial coinfection: A case series.

Arora AA, Krishnaswamy UM, Moideen RP, Padmaja MS - Lung India (2015 Mar-Apr)

Bottom Line: In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response.A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection.We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India.

ABSTRACT
Tuberculosis (TB) is a major public health issue in India. Although dual infection with tuberculosis and bacteria/fungi has been reported in immunocompromised patients, their co-occurrence in individuals with preserved immunity may complicate the clinical presentation, leading to inadequate treatment and unsatisfactory outcomes. In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response. A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection. We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.

No MeSH data available.


Related in: MedlinePlus

(a) Chest radiogram showing right lower zone consolidation with pleural effusion; (b) CT thorax (lung window) showing tree-in-bud appearance with right basal consolidation and pleural effusion
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Figure 2: (a) Chest radiogram showing right lower zone consolidation with pleural effusion; (b) CT thorax (lung window) showing tree-in-bud appearance with right basal consolidation and pleural effusion

Mentions: A 55-year-old male alcohol abuser, presented with fever, productive cough, and exertional breathlessness since two weeks. He had not been on any treatment for the above-mentioned illness before presentation to our hospital. On clinical assessment, the patient had features of severe community acquired pneumonia (CAP). Hence, he was admitted to the high dependency unit (HDU) and routine blood and sputum tests were sent. A chest radiogram revealed right lower zone consolidation with effusion [Figure 2a]. Laboratory investigations were normal, except for a raised ESR. The patient was started on intravenous Cefoperazone–Sulbactam. As fever spikes continued despite 72 hours of antibiotic therapy, pleurocentesis and CT thorax were performed. Reports of the initial sputum sample sent at admission revealed that it was positive for AFB and also grew Klebsiella sensitive only to Meropenem on bacterial culture. Pleural fluid analysis revealed a lymphocyte predominant exudate with raised ADA levels. The CECT thorax showed right lower lobe consolidation and pleural effusion [Figure 2b]. A diagnosis of pulmonary TB with concurrent Klebsiella pneumonia was made. ATT was started and antibiotics were escalated, following which the patient improved clinically and radiologically.


Tubercular and bacterial coinfection: A case series.

Arora AA, Krishnaswamy UM, Moideen RP, Padmaja MS - Lung India (2015 Mar-Apr)

(a) Chest radiogram showing right lower zone consolidation with pleural effusion; (b) CT thorax (lung window) showing tree-in-bud appearance with right basal consolidation and pleural effusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372875&req=5

Figure 2: (a) Chest radiogram showing right lower zone consolidation with pleural effusion; (b) CT thorax (lung window) showing tree-in-bud appearance with right basal consolidation and pleural effusion
Mentions: A 55-year-old male alcohol abuser, presented with fever, productive cough, and exertional breathlessness since two weeks. He had not been on any treatment for the above-mentioned illness before presentation to our hospital. On clinical assessment, the patient had features of severe community acquired pneumonia (CAP). Hence, he was admitted to the high dependency unit (HDU) and routine blood and sputum tests were sent. A chest radiogram revealed right lower zone consolidation with effusion [Figure 2a]. Laboratory investigations were normal, except for a raised ESR. The patient was started on intravenous Cefoperazone–Sulbactam. As fever spikes continued despite 72 hours of antibiotic therapy, pleurocentesis and CT thorax were performed. Reports of the initial sputum sample sent at admission revealed that it was positive for AFB and also grew Klebsiella sensitive only to Meropenem on bacterial culture. Pleural fluid analysis revealed a lymphocyte predominant exudate with raised ADA levels. The CECT thorax showed right lower lobe consolidation and pleural effusion [Figure 2b]. A diagnosis of pulmonary TB with concurrent Klebsiella pneumonia was made. ATT was started and antibiotics were escalated, following which the patient improved clinically and radiologically.

Bottom Line: In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response.A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection.We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India.

ABSTRACT
Tuberculosis (TB) is a major public health issue in India. Although dual infection with tuberculosis and bacteria/fungi has been reported in immunocompromised patients, their co-occurrence in individuals with preserved immunity may complicate the clinical presentation, leading to inadequate treatment and unsatisfactory outcomes. In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response. A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection. We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.

No MeSH data available.


Related in: MedlinePlus