Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 47 , ISSUE 4 ( October-December, 2013 ) > List of Articles

RESEARCH ARTICLE

Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India

Ashim Das, Digambar Behera, Navneet Singh, Ashutosh N Aggarwal

Citation Information : Das A, Behera D, Singh N, Aggarwal AN. Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India. J Postgrad Med Edu Res 2013; 47 (4):177-180.

DOI: 10.5005/jp-journals-10028-1082

Published Online: 00-12-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Chemotherapy is a risk factor for occurrence of infections. Tuberculosis is a common infection in high prevalence countries. Data on incidence of tuberculosis following lung cancer chemotherapy is limited. The current study was conducted to assess the spectrum and clinical profile of pleuro-pulmonary tuberculosis following lung cancer chemotherapy at a tertiary care institute in North India.

Methods

Retrospective data analysis of newly diagnosed lung cancer patients undergoing chemotherapy over a three-and-half year period. Diagnosis of tuberculosis was made by presence of suggestive clinicoradiological features (fever, cough, pleuritic chest pain, new parenchymal infiltrates or new onset pleural effusion on chest imaging) along with demonstration of acid fast bacilli (AFB) in sputum/pleural fluid/bronchoalveolar lavage (BAL) fluid and/or growth of Mycobacterium tuberculosis on culture. For biopsy/cytology specimens, tuberculosis was diagnosed by demonstration of granulomatous inflammation with AFB.

Results

Overall six (0.9%) of 662 lung cancer patients developed tuberculosis [four pulmonary (PTB) and two pleural (TB-PE)]. Occurrence of PTB/TB-PE and of smear-positive PTB after lung cancer chemotherapy was at a rate of 2.59 per 1000 patients/year and 1.73 per 1000 patients/year respectively, compared with national incidences of 1.85 per 1000 population/year and 0.75 per 1000 population/year respectively. Four patients had objective response to chemotherapy. Diagnosis of PTB/TB-PE was established by sputum microscopy, BAL fluid microscopy and pleural biopsy in two patients each. All patients developed tuberculosis on same side as primary tumor. All patients received standard four-drug anti-tubercular therapy (ATT). Median time interval between diagnosis of lung cancer and that of tuberculosis was 144 (56-317) days while time interval between last chemotherapy cycle and diagnosis of tuberculosis was 55 (36-182) days. Median overall survival and survival after diagnosis of tuberculosis were 312 (141-504) days and 174 (41-199) days respectively.

Conclusion

Occurrence of PTB/TB-PE after lung cancer chemotherapy is higher than the corresponding incidence of tuberculosis observed in the general Indian population. Overall survival of these patients is similar to lung cancer patients in general if clinical suspicion of tuberculosis is actively pursued and ATT initiated promptly following diagnosis of tuberculosis.

How to cite this article

Singh N, Madan K, Aggarwal AN, Gupta N, Das A, Behera D. Pleuropulmonary Tuberculosis Following Chemotherapy for Lung Cancer at a Tertiary Care Center in India. J Postgrad Med Edu Res 2013;47(4):177-180.


PDF Share
  1. Shortened survival of lung cancer patients initially presenting with pulmonary tuberculosis. Jpn J Clin Oncol 1996;26:322-327.
  2. The clinical course of respiratory tuberculosis in lung cancer patients. Int J Tuberc Lung Dis 2009;13:1002-1007.
  3. Lung cancer in patients with tuberculosis. World J Surg Oncol 2007;5:22.
  4. Facts and fiction of the relationship between preexisting tuberculosis and lung cancer risk: a systematic review. Int J Cancer 2009;125:2936-2944.
  5. Unchanging clinico-epidemiological profile of lung cancer in North India over three decades. Cancer Epidemiol 2010;34:101-104.
  6. Prevalence of low body mass index among newly diagnosed lung cancer patients in North India and its association with smoking status. Thoracic Cancer 2011;2:27-31.
  7. Quantified smoking status and non-small cell lung cancer stage at presentation: analysis of a North Indian cohort and a systematic review of literature. J Thorac Dis 2012;4:474-484.
  8. Intercycle delays during chemotherapy of non-small cell lung cancer in a health care resource-constrained setting and their effect on overall survival. J Thorac Oncol 2010;5:236-239.
  9. Management of advanced lung cancer in resource-constrained settings: a perspective from India. Expert Rev Anticancer Ther 2012;12:1479-1495.
  10. Staging Manual in Thoracic Oncology, 1st ed. Orange Park, FL, USA: Editorial Rx Press, 2009.
  11. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216.
  12. 2012, New Delhi: Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, 2011. Available at: http://www.tbcindia.nic.in/pdfs/RNTCP%20TB%20India%202011.pdf.
  13. 2012, Geneva: World Health Organization, 2011. Available at http://www.who.int/tb/publications/global_report/en/.
  14. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 1974;33: 850-858.
  15. Reactivation of pulmonary tuberculosis in malignancy. Tumori 2002;88:251-254.
  16. Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy. Chest 2005;128:2218-2222.
  17. Tuberculosis in cancer patients: an update. J Thorac Imaging 1997;12:41-46.
  18. Pleural tuberculosis following lung cancer chemotherapy: a report of two cases proven pathologically by pleural biopsy. BMJ Case Rep 2013;doi:10.1136/bcr-2012-008196: Published 22 January 2013.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.