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

Abstract

BackgroundImmigrants to Germany and their children are at particular risk for tuberculosis (TB).Methods35 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.ResultsPrimary 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 Mycobacterium (M.) tuberculosis complex was positive in only 7/20 (35.0%) cases. M. tuberculosis was identified in 32/35 (91.4%), M. bovis 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.

Extrapulmonary tuberculosis: are statistical reports accurate?

“…It has been well described that the urogenital system is a common site of EPTB in adults, but the true incidence of UGTB is less clear, and reports have varied from 4% to 73% [Singh et al 2011]. …”

The WHO ultrasonography protocol for assessing hepatic morbidity due to Schistosoma mansoni. Acceptance and evolution over 12 years

“…Ultrasonographic differential diagnostic criteria for schistosomiasis are that upper urinary tract 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 obstruction is due to bladder and ureter pathology and thus non-specific whereas in tuberculosis hypoechogenic lesions initiate in the kidney parenchyma also affecting the papillae. In doubtful cases, parasitological and bacteriological means are required for differential diagnosis (Das et al 1992;Tikkakoski et al 1993;Benchekroun et al 1997;Hsieh et al 2006;Singh et al 2011). …”

TB or not TB? Diagnostic difficulties in HIV-positive versus HIV-negative tuberculosis patients with an immigration background in Germany

“…Other difficulties include the fact that, contrary to most European and Extra-European countries, in Germany a medical specialty for infectious diseases did not exist for decades and that especially young German doctors do not have sufficient opportunities to gain experience with the diagnosis of TB. 4 …”

“…2,3 Due to this fact, we carefully anticipate that the number of patients in Germany with an atypical TB manifestation will increase. 4 Therefore the aim of this comparative study was to determine how TB epidemiologically and clinically presents in this patient population and to find out how TB mono-infections differ from TB-HIV co-infections.…”