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Chronic Cough Due to Tuberculosis and Other Infections

ACCP Evidence-Based Clinical Practice Guidelines

Correspondence to: Mark J. Rosen, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, First Ave and 16th St, New York, NY 11021; e-mail: mrosen{at}bethisraely.org

Background: Although tuberculosis (TB) and other lung infections are common throughout the developing world, they are not among the most common causes of chronic cough.

Methods: Articles were selected from a MEDLINE search from 1966 through 2003 (using medical subject heading words "cough," "tuberculosis," and "lung infection"), and World Health Organization and Centers for Disease Control and Prevention web sites.

Results: Because of the contagious nature of TB and its potential for devastating morbidity and mortality for individual patients and society, TB should be considered early on in the workup of patients with chronic cough when the likelihood of active TB is high. On a worldwide basis, many cases of chronic cough are caused by infection including TB, and endemic fungi and parasites are important causes of cough in specific geographic regions. The convergence of the AIDS epidemic with the high prevalence of TB in the developing world has fueled the marked increase in cases of TB. Persons who live and work in facilities like prisons and nursing homes are also susceptible to tuberculous infection, and they spread it to others. Infection with endemic fungi and parasites should be considered in patients with chronic cough who live, or have lived, in these areas.

Conclusion: Patients with unexplained chronic cough who have resided in areas having endemic infection with TB, fungi, or parasites should undergo diagnostic evaluation for these pathogens when more common causes of cough have been ruled out.

Key Words: directly observed therapy, short-course • fungi • infection • influenza • paragonimiasis • parasites • pneumonia • syngamosis • tuberculosis

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