Should one consider tuberculosis if clubbing is present?
The authors suggest that sarcoidosis is unlikely if finger clubbing
is present and alternative diagnoses, including tuberculosis, should be
considered.
A search of several major textbooks including Murray & Nadel's
Textbook of Respiratory Medicine: Mason, 4th Ed (2005 Saunders, An Imprint
of Elsevier); Clinical Respiratory Medicine: Albert, Spiro and Jett, 2nd
Ed (2004 Mosby); The Oxford Textbook of Medicine and the popular Oxford
Handbook of Clinical Medicine reveals that clubbing is not considered a
usual clinical feature of tuberculosis nor is the disease a recognised
cause of finger clubbing. A Medline search reveals two relatively small
studies of only approximately 100 patients each, from Africa, where
approximately one-third of patients with tuberculosis were found to have
clubbing (Reeve et al: Clubbing in African patients with pulmonary
tuberculosis. Thorax DOI:10.1136/thx.42.12.986 and Ddungu et al: Digital
clubbing in tuberculosis - relationship to HIV infection, extent of
disease and hypoalbuminemia. BMC Infectious Diseases DOI: 10.1186/1471-
2334-6-45) The authors of the former paper suggest that clubbing is more
likely to be found in locations where facilities for treatment of
tuberculosis are inadequate.
I wonder if the authors have any other evidence to support their
recommendation - which may confuse readers, and particularly trainees, by
conflicting with usual teaching and leading to a failure to search for
alternative diagnoses when tuberculosis is detected.
Rapid Response:
Should one consider tuberculosis if clubbing is present?
The authors suggest that sarcoidosis is unlikely if finger clubbing
is present and alternative diagnoses, including tuberculosis, should be
considered.
A search of several major textbooks including Murray & Nadel's
Textbook of Respiratory Medicine: Mason, 4th Ed (2005 Saunders, An Imprint
of Elsevier); Clinical Respiratory Medicine: Albert, Spiro and Jett, 2nd
Ed (2004 Mosby); The Oxford Textbook of Medicine and the popular Oxford
Handbook of Clinical Medicine reveals that clubbing is not considered a
usual clinical feature of tuberculosis nor is the disease a recognised
cause of finger clubbing. A Medline search reveals two relatively small
studies of only approximately 100 patients each, from Africa, where
approximately one-third of patients with tuberculosis were found to have
clubbing (Reeve et al: Clubbing in African patients with pulmonary
tuberculosis. Thorax DOI:10.1136/thx.42.12.986 and Ddungu et al: Digital
clubbing in tuberculosis - relationship to HIV infection, extent of
disease and hypoalbuminemia. BMC Infectious Diseases DOI: 10.1186/1471-
2334-6-45) The authors of the former paper suggest that clubbing is more
likely to be found in locations where facilities for treatment of
tuberculosis are inadequate.
I wonder if the authors have any other evidence to support their
recommendation - which may confuse readers, and particularly trainees, by
conflicting with usual teaching and leading to a failure to search for
alternative diagnoses when tuberculosis is detected.
Competing interests:
None declared
Competing interests: No competing interests