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Research article
Naoki Takasaka
The Jikei University Daisan Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3016-233X
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This work is licensed under a CC BY 4.0 License. Read Full License
Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB).
Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥1 based on low attenuation area < -950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment.
Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [ interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p<0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [ hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p=0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p=0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p<0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p=0.015 and 84.21% vs 60.98%; p=0.021, respectively).
Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.
Keywords
tuberculosis, emphysema, culture conversion
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View the published article at BMC Pulmonary Medicine.
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Posted 21 Sep, 2020
No community comments so far
Editorial decision: Accept
On 26 Oct, 2020
Review #2 received
Received 22 Oct, 2020
Review #1 received
Received 08 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Editor assigned
On 13 Sep, 2020
Submission checks complete
On 12 Sep, 2020
Editor invited
On 12 Sep, 2020
No comments provided
Editorial decision: Major revision
On 07 Sep, 2020
Review #1 received
Received 02 Aug, 2020
Reviewer #1 agreed
On 01 Aug, 2020
Reviewers invited
Invitations sent on 27 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
Editor assigned
On 13 Jul, 2020
First submitted
On 09 Jul, 2020
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
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See the published version of this preprint at BMC Pulmonary Medicine.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Naoki Takasaka
The Jikei University Daisan Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3016-233X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Pulmonary Medicine.
Version 2
Posted 21 Sep, 2020
No community comments so far
Editorial decision: Accept
On 26 Oct, 2020
Review #2 received
Received 22 Oct, 2020
Review #1 received
Received 08 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Editor assigned
On 13 Sep, 2020
Submission checks complete
On 12 Sep, 2020
Editor invited
On 12 Sep, 2020
No comments provided
Editorial decision: Major revision
On 07 Sep, 2020
Review #1 received
Received 02 Aug, 2020
Reviewer #1 agreed
On 01 Aug, 2020
Reviewers invited
Invitations sent on 27 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
Editor assigned
On 13 Jul, 2020
First submitted
On 09 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pulmonary Medicine.
Background Although cigarette smoking may have a negative impact on the clinical outcome of pulmonary tuberculosis (PTB), few studies have investigated the impact of smoking-associated lung diseases. Emphysema is a major pathological finding of smoking-related lung damage. We aimed to clarify the effect of emphysema on sputum culture conversion rate for Mycobacterium tuberculosis (MTB).
Methods We retrospectively studied 79 male patients with PTB confirmed by acid-fast bacillus smear and culture at Jikei University Daisan Hospital between January 2015 and December 2018. We investigated the sputum culture conversion rates for MTB after starting standard anti-TB treatment in patients with or without emphysema. Emphysema was defined as Goddard score ≥1 based on low attenuation area < -950 Hounsfield Unit (HU) using computed tomography (CT). We also evaluated the effect on PTB-related CT findings prior to anti-TB treatment.
Results Mycobacterial median time to culture conversion (TCC) in 38 PTB patients with emphysema was 52.0 days [ interquartile range (IQR) 29.0–66.0 days], which was significantly delayed compared with that in 41 patients without emphysema (28.0 days, IQR 14.0–42.0 days) (p<0.001, log-rank test). Multivariate Cox proportional hazards analysis showed that the following were associated with delayed TCC: emphysema [ hazard ratio (HR): 2.43; 95% confidence interval (CI): 1.18–4.97; p=0.015), cavities (HR: 2.15; 95% CI: 1.83–3.89; p=0.012) and baseline time to TB detection within 2 weeks (HR: 2.95; 95% CI: 1.64–5.31; p<0.0001). Cavities and consolidation were more often identified by CT in PTB patients with than without emphysema (71.05% vs 43.90%; p=0.015 and 84.21% vs 60.98%; p=0.021, respectively).
Conclusions This study suggests that emphysema poses an increased risk of delayed TCC in PTB. Emphysema detection by CT might be a useful method for prediction of the duration of PTB treatment required for sputum negative conversion.
Figure 1
Figure 2
Figure 3
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