Kaohsiung Journal of Medical Sciences
Volume 24, Issue 1 , Pages 17-24, January 2008

Clinical Characteristics of Pulmonary Tuberculosis Patients from a Southern Taiwan Hospital-based Survey

  • Chuan-Sheng Wang

      Affiliations

    • Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Huang-Chi Chen

      Affiliations

    • Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Chih-Jen Yang

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Jong-Rung Tsai

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Inn-Wen Chong

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Jhi-Jhu Hwang

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ming-Shyan Huang

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Ming-Shyan Huang, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan

Received 27 March 2007; accepted 10 August 2007.

Article Outline

This study aimed to identify the clinical characteristics of culture-positive pulmonary tuberculosis (TB) patients from a southern Taiwan hospital-based survey between August 1, 2003 and July 31, 2006. Demographics, symptoms, susceptibility patterns, sputum acid-fast bacilli (AFB) stain status and treatment outcomes were recorded. The medical records of 154 patients who presented to the Kaohsiung Municipal Hsiao-Kang Hospital were analyzed retrospectively. The mean age of patients was 59.5 years; 115 patients were male and 39 were female. Diabetes mellitus (48/154; 31.2%) was the most frequent risk factor for pulmonary TB infection. Nearly all patients (139/154; 90.3%) had a cough. Fever was only seen in 27.9% and hemoptysis in 14.9% of patients. The combined resistance rates of Mycobacterium tuberculosis to the tested first-line agents were as follows: isoniazid, 3.2%; rifampin, 7.8%; ethambutol, 5.8%; and streptomycin, 2.6%. The combined resistance rate to any one of four first-line drugs was 12.3%. The combined resistance rate to ofloxacin was 3.9%. The combined resistance rate of multidrug resistant-TB was 1.9%. Sputum AFB stains were positive in 68.2% of cases. Analysis of treatment outcomes showed overall treatment success at 76.6%. The proportions of patients who died, defaulted treatment or in whom treatment failed were 16.2%, 3.9% and 0.0%, respectively. In conclusion, our study showed: (1) a higher frequency of pulmonary TB in male subjects than in other areas of Taiwan; (2) a higher frequency of cough and lower frequency of fever and hemoptysis than previous studies; (3) that the combined resistance rates to isoniazid and streptomycin were lower than both average levels in Taiwan and the global combined drug resistance rate; and (4) a higher proportion of patients responding to treatment and lower proportions of patients suffering mortality, defaulting treatment or not responding to treatment compared with other areas of Taiwan. With regard to resistance rates, the combined resistance rate to ethambutol was similar to the average level in Taiwan and higher than the global combined drug resistance rate. However, the combined resistance rate to rifampin was higher than both the average level in Taiwan and the global combined drug resistance rate. The combined resistance rates to at least any one of four first-line drugs and multidrug resistant-TB were lower than the average levels in Taiwan and higher than the global combined drug resistance rate. Our results may help to identify local variations in the disease and improve the effectiveness of TB infection control programs.

Key Words:  pulmonary tuberculosis , resistance , symptom , Taiwan , treatment outcome

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Dye C , Watt CJ , Bleed DM , et al.   Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally . JAMA . 2005;293:2767–2775
  2. Center for Disease Control, Department of Health, Executive Yuan, Taiwan. Tuberculosis Annual Report (Taiwan). Taipei: Center for Disease Control, Department of Health, June 2006. Available from http://www.cdc.gov.tw [Date accessed: March 3, 2007]
  3. World Health Organization. Anti-tuberculosis Drug Resistance in the World, Report No. 3. Geneva: WHO. Available from http://www.who.int/tb/publications/who_htm_tb_2004_343/en/index.html [Date accessed: March 3, 2007]
  4. Hsueh PR , Liu CY , Luh KT . Current status of antimicrobial resistance in Taiwan . Emerg Infect Dis . 2002;8:132–137
  5. Lu PL , Lee YW , Peng CF , et al.   The decline of high drug resistance rate of pulmonary Mycobacterium tuberculosis isolates from a southern Taiwan medical centre, 1996–2000 . Int J Antimicrob Agents . 2003;21:239–243
  6. World Health Organization  . Treatment of Tuberculosis: Guidelines for National Programmes . 3rd edition. Geneva: WHO; 2003; WHO/CDS/TB/2003.313 Available from http://www.who.int/tb/publications/global_report/en/ [Date accessed: March 3, 2007]
  7. Chan CH , Woo J , Or KK , et al.   The effect of age on the presentation of patients with tuberculosis . Tuber Lung Dis . 1995;76:290–294
  8. Chan-Yeung M , Noertjojo K , Tan J , et al.   Tuberculosis in the elderly in Hong Kong . Int J Tuberc Lung Dis . 2002;6:771–779
  9. Liaw YS , Yang PC , Yu CJ , et al.   Clinical spectrum of tuberculosis in older patients . J Am Geriatr Soc . 1995;43:256–260
  10. Stead WW , To T . The significance of the tuberculin skin test in elderly persons . Ann Intern Med . 1987;107:837–842
  11. Bener A . Prevalence of tuberculosis infection in ABHA and BAHA . Eur J Epidemiol . 1990;6:376–381
  12. Hsueh PR , Liu YC , So J , et al.   Mycobacterium tuberculosis in Taiwan . J Infect . 2006;52:77–85
  13. Alisjahbana B , van Crevel R , Sahiratmadja E , et al.   Diabetes mellitus is strongly associated with tuberculosis in Indonesia . Int J Tuberc Lung Dis . 2006;10:696–700
  14. Nissapatorn V , Kuppusamy I , Jamaiah I , et al.   Tuberculosis in diabetic patients: a clinical perspective . Southeast Asian J Trop Med Public Health . 2005;36(Suppl 4):213–220
  15. Perez A , Brown HS , Restrepo BI . Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas . Am J Trop Med Hyg . 2006;74:604–611
  16. Korzeniewska-Kosela M , Krysl J , Muller N , et al.   Tuberculosis in young adults and the elderly. A prospective comparison study . Chest . 1994;106:28–32
  17. Katz PR , Reichman W , Dube D , et al.   Clinical features of pulmonary tuberculosis in young and old veterans . J Am Geriatr Soc . 1987;35:512–515
  18. Herer B , Kuaban C , Papillon F , et al.   Features in hospitalized patients with symptom-detected or radiologicallydetected pulmonary tuberculosis . Eur Respir J . 1989;2:3–6
  19. Rathman G , Sillah J , Hill PC , et al.   Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia . Int J Tuberc Lung Dis . 2003;7:942–947
  20. El-Khushman H , Momani JA , Sharara AM , et al.   The pattern of active pulmonary tuberculosis in adults at King Hussein Medical Center, Jordan . Saudi Med J . 2006;27:633–636
  21. Mathur P , Sacks L , Auten G , et al.   Delayed diagnosis of pulmonary tuberculosis in city hospitals . Arch Intern Med . 1994;154:306–310
  22. Counsell SR , Tan JS , Dittus RS . Unsuspected pulmonary tuberculosis in a community teaching hospital . Arch Intern Med . 1989;149:1274–1278
  23. Tsao TC , Chiou W , Lin H , et al.   Change in demographic picture and increase of drug resistance in pulmonary tuberculosis in a 10-year interval in Taiwan . Infection . 2002;30:75–80
  24. Wang PD , Lin RS . Drug-resistant tuberculosis in Taipei, 1996–1999 . Am J Infect Control . 2001;29:41–47
  25. Yu MC , Suo J , Chiang CY , et al.   Initial drug resistance of Mycobacterium tuberculosis in Taiwan . J Formos Med Assoc . 1997;96:890–894
  26. Chiang IH , Yu MC , Bai KJ , et al.   Drug resistance patterns of tuberculosis in Taiwan . J Formos Med Assoc . 1998;97:581–583
  27. Liu CE , Chen CH , Hsiao JH , et al.   Drug resistance of Mycobacterium tuberculosis complex in central Taiwan . J Microbiol Immunol Infect . 2004;37:295–300
  28. Su WJ , Lee PY , Yu KW , et al.   Drug resistance of Mycobacterium tuberculosis isolated from patients at a medical center in Taiwan . Zhonghua Yi Xue Za Zhi (Taipei) . 1997;60:21–27
  29. Liaw YS , Hsueh PR , Yu CJ , et al.   Drug resistance pattern of Mycobacterium tuberculosis in a university hospital in Taiwan, 1998–2002 . J Formos Med Assoc . 2004;103:671–677
  30. Yu MC , Suo J , Lin TP , et al.   In vitro activity of ofloxacin against Mycobacterium tuberculosis . J Formos Med Assoc . 1997;96:13–16
  31. Center for Disease Control, Department of Health, Executive Yuan, Taiwan. Statistics of Communicable Diseases and Surveillance Report in Taiwan Area, 2003. Taipei: Center for Disease Control, Department of Health. Available from http://www.cdc.gov.tw/en/index.asp [Date accessed: March 3, 2007]

PII: S1607-551X(08)70068-8

doi:10.1016/S1607-551X(08)70068-8

Kaohsiung Journal of Medical Sciences
Volume 24, Issue 1 , Pages 17-24, January 2008

Article Tools