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 [
[1]
], but, also to the misdiagnosis of pulmonary tuberculosis (PTB) as CAP [
[2]
]. 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” [
[2]
]. This might be especially the case, not only when PTB presents as an acute illness
[
[2]
], but also when there is dual infection with m.tuberculosis and non-mycobacterial
organisms [
[3]
]. 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 [
[4]
].To read this article in full you will need to make a payment
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References
- Adherence to antibiotic guidelines and outcomes in the hospitalized elderly with different types of pneumonia.Eur J Intern Med. 2015; 26: 330-337
- Acute tuberculosis.Infect Dis Clin North Am. 2010; 24: 139-146
- Characteristics and outcomes of patients with dual pulmonary tuberculosis and non-mycobacterial respiratory infections.J Clin Med Res. 2011; 3: 309-318
- Nursing home acquired pneumonia: a 10 year single-centre experience.Thorax. 2010; 65: 354-359
- Concomitant pulmonary tuberculosis in hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: a multicentre retrospective study.PLoS One. 2012; 7e36832
- What is tuberculosis surveillance in the European Union telling us?.Clin Infect Dis. 2007; 44: 1261-1267
- Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes.Am J Respir Crit Care Med. 2000; 162: 1738-1740
- Impact of fluoroquinolines on the diagnosis of pulmonary tuberculosis initially treated as bacterial pneumonia.Int J Tuberc Lung Dis. 2005; 9: 1215-1219
- Unsuspected pulmonary tuberculosis in a community teaching hospital.Arch Intern Med. 1989; 149: 1274-1278
Article info
Publication history
Published online: August 27, 2015
Accepted:
August 13,
2015
Received:
August 12,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
