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. 2019 Mar 11;19(1):60.
doi: 10.1186/s12890-019-0828-4.

Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study

Engi F Attia  1   2 , Yaty Pho  1   2 , Somary Nhem  3 , Chandara Sok  3 , Borady By  3 , Dariven Phann  3 , Huy Nob  1   2 , Sovanndeth Thann  3 , Sinath Yin  3 , Rachael Noce  1   4 , Chamrouensann Kim  5 , Joanne Letchford  6 , Thomas Fassier  7 , Sarin Chan  7   8 , T Eoin West  9   10
Affiliations

Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study

Engi F Attia et al. BMC Pulm Med. .

Abstract

Background: Cambodia, a lower middle-income country of about 16 million individuals in southeast Asia, endures a high burden of both tuberculosis and other lower respiratory infections. Differentiating tuberculosis from other causes of respiratory infection has important clinical implications yet may be challenging to accomplish in the absence of diagnostic microbiology facilities. Furthermore, co-infection of tuberculosis with other bacterial lower respiratory infections may occur. The objective of this study was to determine the prevalence and etiologies of tuberculosis and other bacterial co-infection and to analyze the clinical and radiographic characteristics of patients presenting with respiratory infection to a provincial referral hospital in Cambodia.

Methods: We performed a retrospective, cross-sectional analysis of laboratory and clinical data, on patients presenting with respiratory symptoms to a chest clinic of a 260-bed provincial referral hospital in Cambodia. We analyzed mycobacterial and bacterial sputum test results, and demographics, medical history and chest radiography.

Results: Among 137 patients whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, the median age was 52 years, 54% were male, 3% had HIV infection, and 26% were current smokers. Nearly all had chronic respiratory symptoms (> 96%) and abnormal chest radiographs (87%). Sputum testing was positive for tuberculosis in 40 patients (30%) and for bacteria in 60 patients (44%); 13 had tuberculosis and bacterial co-infection (9% overall; 33% of tuberculosis patients). Clinical characteristics were generally similar across pulmonary infection types, although co-infection was identified in 43% of patients with one or more cavitary lesions on chest radiography. Among those with bacterial growth on sputum culture, Gram negative bacilli (Klebsiella and Pseudomonas spp.) were the most commonly isolated.

Conclusions: Among patients with symptoms of respiratory infections whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, 9% of all patients and 33% of tuberculosis patients had tuberculosis and bacterial co-infection. Greater availability of microbiologic diagnostics for pulmonary tuberculosis and bacterial infection is critical to ensure appropriate diagnosis and management.

Keywords: Cambodia; Diagnostics; Lung; Pneumonia; Respiratory infection; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

Human subjects approval was granted by the National Ethics Committee of Health Research of Cambodia and by the University of Washington Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Consent for publication

Not applicable

Competing interests

EFA has received research grants from the US National Institutes of Health and the Thrasher Research Fund. TEW has received research grants from the US National Institutes of Health, the Firland Foundation, the Doris Duke Charitable Foundation, and the US Defense Threat Reduction Agency.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Organisms identified in sputum stratified by chest radiograph findings. The exact test p-value comparing types of identified organisms in the sputum (TB and/or bacteria) across categories of chest radiograph findings was < 0.001. The “Other abnormalities” category comprises fibrosis, bronchiectasis, and bronchitis
See this image and copyright information in PMC

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