Dual infection in tuberculous pneumonia

Recognition of tuberculous pneumonia is important, not only in its own right1 but also in those patients who have pneumonia attributable to dual infection withMycobacteriumtuberculosis and bacterial pathogens.2,3 Antedating the human immune deficiency virus (HIV) era, this phenomenon was exemplified by a 45-year-old man, who had an initial diagnosis of radiographically validated pneumonic consolidation of the right upper and middle lobes, subsequently complicated by the development of meningitis. A casual sputum smear was negative for acid-fast bacilli but the Gram smear showed Gram-positive diplococci. The cerebrospinal fluid initially showed only Gram-positive diplococci. After penicillin treatment, his clinical course was punctuated by the identification of acid fast bacilli on sputum smear on the 13th and 19th hospital days, and on direct smear of the CSF on the 13th and 15th hospital days. These findings were dismissed as laboratory errors, and he did not receive antituberculous treatment. On the 50th hospital day, he relapsed and subsequently died. At autopsy, the right upper lobe contained several multiloculated cavities. Histological examination revealed caseous necrosis associated with infiltration by multinucleated giant cells.2 There is also a report of nine HIV-positive patients who presented with lobar or multilobar consolidation in association withStreptococcus pneumoniae bacteraemia. Because of suboptimal response to antibiotics, all nine were investigated furt...
Source: QJM - Category: Internal Medicine Source Type: research