Pulmonary tuberculosis presenting as community-acquired pneumonia

Objective and background: The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP. Methods: A prospective study was performed on consecutive non-immunocompromised patients aged 12 years and older, who were hospitalized for CAP. Results: Of a total of 346 patients hospitalized for CAP, the aetiological agent was identified in 163 patients (47.1%). M. tuberculosis was isolated in 17 patients (4.9%). Multivariate analysis revealed that the following features were significantly associated with culture-positive PTB: duration of symptoms of more than 2 weeks before hospital admission (odds ratio (OR) 25.10; 95% confidence interval (CI) 4.63-136.05; P < 0.001), history of night sweats (OR 5.43; 95% CI 1.10-26.79; P = 0.038), chest radiograph showing upper lobe involvement (OR 8.23; 95% CI 1.59-42.53; P = 0.012) or cavitary infiltrates (OR 19.41; 95% CI 2.94-128.19; P = 0.002), total white blood cell count on admission of 12 x 10(9)/L or less (OR 6.28; 95% CI 1.21-32.52; P = 0.029) and lymphopenia (OR 4.73; 95% CI 1.08-20.85; P = 0.040). Conclusion: Mycobacterium tuberculosis was not an uncommon cause of CAP requiring hospitalization in Malaysia. A longer duration of symptoms, history of night sweats, upper lobe involvement, cavitary infiltrates, lower total white blood cell count and lymphopenia were predictive of PTB.