Editorial

One Patient, Many Lessons

Authors: Wendy Gerstein, MD

Abstract

Extrapulmonary tuberculosis (TB) represents approximately 20% of all TB infections, which translates into 400 million cases worldwide. Patients with extrapulmonary disease are more likely than not to have a normal CXR, a negative PPD, and a 40 to 50% chance of underlying human immunodeficiency virus (HIV) infection.1–3 The implication of these numbers is that extrapulmonary TB should be in the differential diagnosis of essentially any case that is not responding to seemingly appropriate therapy. This is particularly true in TB endemic areas, as the case submitted by Drs. Lee and Liu in this issue of the Journal so nicely illustrates. The case also raises other pertinent issues that all clinicians are likely to confront as TB and HIV epidemics continue to ravage the health of the world's citizens.

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References

1. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practices of Infectious Diseases, 6th ed. Philadelphia: Elsevier Churchhill Living Stone, 2005, pp 2852–2883.
 
2. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician 2005;72:1761–1768.
 
3. Kourbatova EV, Leonard MK Jr, Romero J, et al. Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US. Eur J Epidemiol 2006;21:715–721.
 
4. Patel SM, Saravolatz LD. Monotherapy versus combination therapy. Med Clin North Am 2006;90:1183–1195.
 
5. Osteomyelitis. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases, 6th ed. 2005, pp 1322–1330.
 
6. Centers for Disease Control and Prevention (CDC). Use of social networks to identify persons with undiagnosed HIV infection: seven US cities, October 2003 to September 2004. MMWR Morb Mortal Wkly Rep 2005;54:601–605.
 
7. Bradley-Springer LA, Everett MR, Rotach EG, et al. Changes in clinician ability to assess risk and help patients determine the need for HIV testing: a comparison of three teaching methods. Eval Health Prof 2006;29:367–393.
 
8. Chen Z, Branson B, Ballenger A, et al. Risk assessment to improve targeting of HIV counseling and testing services for STD clinic patients. Sex Transm Dis 1998;25:539–543.
 
9. Greenwald JL, Rich CA, Bessega S, et al. Evaluation of the Centers for Disease Control and Prevention's recommendations regarding routine testing for human immunodefiency virus by an inpatient service: who are we missing? Mayo Clin Proc 2006;81:452–458.
 
10. Dinnes J, Deeks J, Kunst H, et al. A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess 2007;11:1–196.
 
11. Moore DAJ, Evans CAW, Gilman RH, et al. Microscopic-observation drug susceptibility assay for the diagnosis of TB. N Engl J Med 2006;355:1539–1550.