The pattern of active pulmonary tuberculosis in adults at King Hussein Medical Center, Jordan

OBJECTIVE: To identify the pattern of the clinical, radiological, and diagnostic procedures of the diagnosed cases of active pulmonary tuberculosis (TB) patients presented to the Respiratory Medicine Division at King Hussein Medical Center over the last 10 years.

METHODS: This is a retrospective analysis of the medical records and chest radiographs of 137 active pulmonary TB patients who were diagnosed between March 1995 and October 2005. Patient's symptoms were recorded and analyzed. Radiological findings were assessed. Procedures used to identify Mycobacterium TB were identified.

RESULTS: One hundred and thirty-seven patients medical records were retrieved and analyzed (84 males and 53 females). The mean age (range) was 48.43 ± 14.65 (14-83) years. The most common presenting symptoms were cough (79%), weight loss (74%), and fatigue (69%). Other presenting complaints were fever (69%), excessive night sweating (55%), chest pain (41%) and dyspnea (39%). Thirty-one percent of the cohort presented with hemoptysis. Seventy-one patients had different types of opacities and infiltrates in their chest x-ray. Micro- or macro- nodular lung changes were reported in 22 (16%) patients. Lung cavitations and pleural effusions were present in 13% of the studied patients. In 7% of cases, bronchiectasis was noted as a sequelae of long-standing lung disease. The right lung was involved in 51% of cases; the left lung in 27% and bilateral lung involvement was noted in 22% of patients. The upper lobes were involved in 63%. Sputum for acid-fast bacilli (AFB) Z-Nielson stain and culture was positive in 51%, bronchial wash was positive in 27% of cases. The diagnosis was made by histopathological examination in 15% of cases.

CONCLUSION: This study showed that active pulmonary TB patients vary in clinical presentation. The radiological manifestations of pulmonary TB are heterogeneous. Sputum for AFB remains an important, easy and inexpensive measure for TB diagnosis, but may not be always helpful in early diagnosis. Bronchoscopy with bronchial washings for Mycobacterium stain and culture is an important method, and it helps in confirming the diagnosis in sputum negative patients. In sputum and bronchial wash negative cases histopathological diagnosis can identify an important proportion of active pulmonary TB cases.