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The issue of dual infection with m.tuberculosis and non-mycobacterial pathogens

Published:August 27, 2015DOI:https://doi.org/10.1016/j.ejim.2015.08.009
      In order to address more fully the mortality rate associated with pneumonia in the elderly, attention should be paid, not only to adherence to guidelines [
      • Rossio R.
      • Franchi C.
      • Ardoino I.
      • Djade C.
      • Tettamanti M.
      • Pasina L
      Adherence to antibiotic guidelines and outcomes in the hospitalized elderly with different types of pneumonia.
      ], but, also to the misdiagnosis of pulmonary tuberculosis (PTB) as CAP [
      • Schlossberg D.
      Acute tuberculosis.
      ]. Misdiagnosis is, according to one view, attributable to the fact that “rigid adherence to guidelines tends to quickly categorise patients as CAP, after which a treatment algorithm is followed that covers common bacterial and non bacterial organisms” [
      • Schlossberg D.
      Acute tuberculosis.
      ]. This might be especially the case, not only when PTB presents as an acute illness [
      • Schlossberg D.
      Acute tuberculosis.
      ], but also when there is dual infection with m.tuberculosis and non-mycobacterial organisms [
      • Lin G.-M.
      • Chang F.-Y.
      • Chou C.-H.
      • Lin Y.-P.
      • Ku C.-H.
      Characteristics and outcomes of patients with dual pulmonary tuberculosis and non-mycobacterial respiratory infections.
      ]. These issues can be addressed by ensuring that the work up of suspected bacterial pneumonia in the elderly should routinely include sputum smear for acid fast bacilli and culture for m.tuberculosis as was the case in a Spanish study of nursing home-acquired pneumonia [
      • Polverino E.
      • Dambrava P.
      • Cilloniz C.
      • Balasso V.
      • Marcos M.A.
      • Esquinas C.
      • et al.
      Nursing home acquired pneumonia: a 10 year single-centre experience.
      ].
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