Small cavitary lesions were seen in three patients, and lymphadenopathy was seen on CXR in one patient and on gallium scan in three patients. No patient had extrapulmonary disease alone.
There was no evident correlation of our patients in regard to ward and time of hospitalization. This also included water supplies, ice machines, inhalation therapy, and endoscopies.
The two patients with dissemination responded to antituberculosis treatment (patients 1 and 2). Among those with possible disease, six were treated with antituberculosis medication. They had subjective improvement and the fever resolved (patients 3, 5, 8, 10, 11, and 13), although in four of them this could have been secondary to treatment of concomitant disease (patients 5, 3, 8, and 11).
Six of these 12 patients with possible disease died of severe concomitant disease: 3 had bacteremia (Pseudomonas aeruginosa, Enterococ-cus faecalis, methicillin-resistant Staphylococcus aureus), one had disseminated Histoplasjna capsulatum, one had pulmonary Kaposi’s sarcoma, and one had a mixed bacterial pneumonia. Patient 8 was treated with broad-spectrum antibiotics, and patient 11 was treated for Pseudomonas pneumonia. Patient 13 did not have documented dissemination, but showed remarkable improvement of his long-standing fever within 5 days of receiving antituberculosis therapy after having received multiple antibiotics for several weeks. Patient 10 had significant response of his multiple splenic abscesses as shown by a repeated CT scan. Patients 4, 6, and 9 never received therapy and died within the next 8 weeks, although a meaningful cause-effect conclusion cannot be drawn. Patient 14 had numerous AFB in the sputum and died 3 days after hospital admission without therapy. None of our patients had concomitant M tuberculosis infection and in view of the extensive diagnostic workup, we do not think that M tuberculosis had been missed.