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TB may mimic invasive pulmonary aspergillosis in transplant recipients
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Certain CT findings may help distinguish between pulmonary tuberculosis and invasive pulmonary aspergillosis in transplant recipients, according to recent data.
“In general, the common CT findings of postprimary pulmonary TB … are helpful in distinguishing it from other pulmonary infectious diseases,” the researchers wrote in Clinical Infectious Diseases. “However, the radiologic features of pulmonary TB in immunocompromised patients can vary. As a result, the CT findings of pulmonary TB in transplant recipients are occasionally confused with those of invasive pulmonary aspergillosis (IPA).”
Sung-Han Kim, MD, of the department of infectious diseases at Asan Medical Center, University of Ulsan College of Medicine in Seoul, South Korea, and colleagues evaluated adult transplant recipients at a tertiary hospital who developed pulmonary TB or IPA from January 2008 to December 2013. Initially, they determined if two independent radiologists could distinguish TB and IPA in 78 blind CT images: 28 of TB and 50 with IPA. The researchers then evaluated 108 CT scans to characterize attributes that would help distinguish TB and IPA.
In the blind review, the sensitivity for radiologist A was 78%, and it was 68% for radiologist B for the diagnosis of IPA, with poor agreement (kappa value = 0.25). For TB, the sensitivity for radiologist A was 64% and for radiologist B, the sensitivity was 61%, with excellent agreement (kappa value = 0.77). When comparing the CT findings, the researchers identified infarct-shaped consolidations, multiple macronodules and smooth bronchial wall thickenings as more common findings in IPA. In TB, more common findings included mass-shaped consolidations and centrilobular nodules (< 10 mm, clustered).
The researchers said 29% of the patients with TB received empirical antifungal treatment before definitive anti-TB treatment, suggesting that the patients were initially diagnosed with IPA.
“The CT findings of about one-third of pulmonary TB cases in transplant recipients were very close to those of IPA,” the researchers wrote. “Clinical suspicion and appropriate microbiologic work-up for pulmonary TB are warranted in transplant recipients who are suspected of having IPA, especially in intermediate or high-TB burden countries.” – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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