The pathological correlation between pulmonary tuberculosis and sarcoidosis patients and the impact of presence of nodules on pulmonary tuberculosis patients.

INTRODUCTION

Both pulmonary tuberculosis (PTB) and sarcoidosis (SA) are chronic, systemic, granulomatous diseases. Due to their similar clinical and radiological features, as well as similar pathological characteristics, it is difficult to distinguish. This study aims to explore the pathological correlation between PTB and SA and the impact of nodules formation on the occurrence of PTB.

METHODS

We retrospective enrolled 307 patients admitted to the tuberculosis department between January 2022 and March 2024. After applying the inclusion and exclusion criteria, 170 patients were divided into three groups and analyzed: sarcoid tuberculosis group (TB-N, n=59), non-sarcoid tuberculosis group (TB-NoN, n=74), and sarcoidosis group (SA, n=37). Comparative analysis was performed on the clinical characteristics, pathogen profiles, and pulmonary microbial composition differences among the three groups.

RESULTS

Patients in the TB-N and SA group predominantly presented with multiple nodules. Among samples testing positive by both mNGS and conventional microbiological tests (CMT), the proportion of partially matched results was higher in the TB-N group than in the TB-NoN group, with a greater diversity of pathogenic bacteria detected in the TB-N group. ACE index analysis revealed significantly higher microbial richness in the TB-NoN group compared to both SA and TB-N groups. Regarding treatment regimens, combination therapy was more frequently administered in the TB-N group, while single drug treatment predominated in the TB-NoN group. Although the duration of anti-tuberculosis treatment was longer in the TB-N group, this difference did not reach statistical significance.

DISCUSSION: Significant differences in imaging manifestations were observed between TB-N and SA groups. The presence of nodules was associated with a more complex pathogen profile in PTB patients; however, the pulmonary microbial diversity was lower in TB-N than in TB-NoN. PTB patients with nodules predominantly received combination therapy.