The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

Abstract

<jats:title>Abstract</jats:title><jats:p>According to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Streptococcus pneumoniae remains the most common cause of CAP. However, although well documented, it is not widely appreciated that in several parts of the world, including sub-Saharan Africa, Asia, and South America, Mycobacterium tuberculosis is an important cause of CAP, if not the most common organism isolated in such settings. Thus, CAP due to M. tuberculosis is not uncommon in some parts of the world with up to a third of cases being attributable to M. tuberculosis. Consequently, TB remains an important clinical entity in the intensive care unit in these settings. Despite its frequency and importance, there are very limited data about TB CAP. In this review we discussed the epidemiology, immunopathogenesis, clinical presentation, diagnosis, management, prognosis, and prevention of TB CAP. The utility of newer diagnostic approaches is highlighted.</jats:p>

A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2

“…TB can often present as acute pneumonia or acute lower respiratory tract infection (LRTI), and Mtb may be among the most common pathogens isolated in this context in Asian and African settings (reviewed in detail in a recent article). [54] In a large study from SA ( n =2 500 patients), a symptom duration threshold of >14 days was unable to distinguish between TB and other respiratory pathogens, and in those with LRTI of <14 days duration, TB was the microbiologically-proven diagnosis in ~18% of patients. [59] This figure is remarkable, considering that in patients with acute LRTI, a microbiological diagnosis is made in only ~50% of cases.…”

“…Clinical diagnosis is difficult because there are overlapping risk factors, a multitude of possible presentations (including non-specific symptoms such as fever or cough), and often more than one infection. [13 - 15 , 17 , 54 , 55] If assessing HWs are not adequately protected, this can be a major opportunity for transmission to occur. Transmission of SARS-CoV-2 by asymptomatic individuals has been widely documented, [6] and the burden of ‘subclinical’ TB [56] in SA is increasingly evident.…”

A position statement and practical guide to the use of particulate filtering facepiece (N95, FFP2, or equivalent) respirators for South African health care workers exposed to respiratory pathogens including M. tuberculosis and SARS-CoV-2

“…TB can often present as acute pneumonia or acute lower respiratory tract infection (LRTI), and M.tb may be amongst the most common pathogens isolated in this context in Asian and African settings (reviewed in detail in a recent article). [47] In a large study from South Africa (n ≈ 2500 patients), a symptom duration threshold of >14 days was unable to distinguish between TB and other respiratory pathogens, and, in those with LRTI of less than 14 days duration, TB was the microbiologically-proven diagnosis in a staggering ~18% of patients. [52] This figure is remarkable, considering that in patients with acute LRTI a microbiological diagnosis is made in only ~50% of cases.…”

“…Because of the multitude of possible presentations, non-specific symptoms (e.g., fever, cough), overlapping risk factors, and likelihood of dual infection, [11][12][13][14]47,48] it is impossible to make a specific diagnosis of TB, COVID-19, or other respiratory infection in most South African health facilities without detailed clinical assessment and laboratory investigation, usually over a period of at least 24-72 hours (the turnaround time of most diagnostic tests). If the HCW is not adequately protected, this represents is a major opportunity for transmission to occur.…”

A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2

“…Clinical diagnosis is difficult because there are overlapping risk factors, a multitude of possible presentations (including non-specific symptoms such as fever or cough), and often more than one infection. [13][14][15]17,54,55] If assessing HWs are not adequately protected, this can be a major opportunity for transmission to occur. Transmission of SARS-CoV-2 by asymptomatic individuals has been widely documented, [6] and the burden of 'subclinical' TB [56] in SA is increasingly evident.…”