Difficulty in diagnosing tuberculosis in patients infected by the human immunodeficiency virus (HIV) and variables that determine the initiation of an empirical anti-tuberculosis treatment
Keywords:
TUBERCULOSIS, HIV INFECTIONS, ACQUIRED IMMUNODEFICIENCY SYNDROME, TIMELY AIDS-RELATED INFECTIONS, MYCOBACTERIUM INFECTIONSAbstract
Background: coexistence of HIV and tuberculosis (TB) difficults TB diagnosis and delays indication of specific treatments. In order to identify variables that complicate TB diagnosis we conducted a review of empirical antituberculosis treatments iniciated five years ago in the Infectious Diseases Department (Cátedra de Enfermedades Infecciosas).
Methods: a descriptive retrospective study.
Definitions: confirmed TB: Mycobacterium tuberculosis culture. Highly probable TB: granuloma or caseum in cytology/histopathology or bacilli positive. Probable TB: fever remission 15 days before start of treatment and patient alive at discharge. Not confirmed TB or no TB: not reach any of the above criteria or explicit other diagnosis. Group A: confirmed TB and highly probable TB; group B: probable TB.
Results: ninety-two patients were included in the study. Group A: 82% (n = 75), they were considered as truly TB. A significative difference was recorded at the CD4 level between group A and B, 234 + 120 cells/ml and 94 + 72 cells/ml respectively (p = 0.0007).
A group of variables determine the start of the empirical treatment in most of the patients: associated prolonged fever, respiratory clinic and compatible imaging were the most frequent.
Conclusions: severe immunodepression difficults definitive diagnosis of TB. The identification of variables allows the start of empirical antituberculosis treatment in patients with HIV with a high score of posterior success.
References
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(24) Santos ES, Raez LE, Eckardt P, DeCesare T, Whitcomb CC, Byrne GE. The utility of a bone marrow biopsy in diagnosing the source of fever of unknown origin in patients with AIDS. J Acquir Immune Defic Syndr 2004; 37: 1599-603.
(25) Perlman DC, El-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, et al. Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. Clin Infect Dis 1997; 25: 242-6.
(26) Jasmer RM, Gotway MB, Creasman JM, Webb WR, Edinburgh KJ, Huang L. Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients. J Acquir Immune Defic Syndr 2002; 31: 291-8.
(2) Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med 2003; 163: 1009-21.
(3) Havlir DV, Barnes PE. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1999; 340: 367-73.
(4) Girardi E, Raviglioni MC, Antonucci G, Godfrey-Faussett P, Ippolito G. Impact of the HIV epidemic on the spread of other diseases: the case of tuberculosis. AIDS 2000; 14 (suppl 3): S47-56.
(5) Aderaye G, Bruchfeld J, Assefa G, Feleke D, Kallenius G, Baat M, et al. The relationship between disease pattern and disease burden by chest radiography, M. tuberculosis Load, and HIV status in patients with pulmonary tuberculosis in Addis Ababa. Infection 2004; 32: 333-8.
(6) Karstaedt AS, Jones N, Khoosal M, Crewe-Brown HH. The bacteriology of pulmonary tuberculosis in a population with high human immunodeficiency virus seroprevalence. Int J Tuberc Lung Dis 1998; 2: 312-6.
(7) Johnson JL, Vjecha MJ, Okwera A, Hatanga E, Byekwaso F, Wolski K, et al. Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda. Int J Tuberc Lung Dis 1998; 2: 397-404.
(8) Al Zahrani K, Al Jahdali H, Poirier L, René P, Menzies D. Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis. Int J Tuberc Lung Dis 2001; 5: 855-90.
(9) Conde MB, Soares SL, Mello FC, Rezende VM, Almeida LL, Reingold AL, et al. Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculous. Am J Respir Crit Care Med 2000; 162: 2238-40.
(10) McWilliams T, Wells AU, Harrison AC, Lindstrom S, Cameron RJ, Foskin E. Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis. Thorax 2002; 57: 1010-4.
(11) Kanaya AM, Glidden DV, Chambers HF. Identifying pulmonary tuberculosis in patients with negative sputum smear results. Chest 2001; 120: 349-55.
(12) Kamran S, Lambert ML, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis 2003; 3: 288-96.
(13) Palmieri F, Girardi E, Pellicelli AM, Rianda A, Bordi E, Rizzi EB, et al. Pulmonary tuberculosis in HIV-infected patients presenting with normal chest radiograph and negative sputum smear. Infection 2002; 30: 68-74.
(14) Medina J, Cabrera S, Hernández O, Librán M, González H, Savio E. Identificación de variables que determinan la imposibilidad de un diagnóstico de Tuberculosis. Congreso de la Asociación Panamericana de Infectología, 12 Caracas, 15-18 mayo 2005.
(15) Medina J, Cabrera S, Hernández O, Librán M, González H, Savio E. Justificación del tratamiento empírico antituberculoso en población VIH. Congreso de la Asociación Panamericana de Infectología,12 Caracas, 15-18 mayo 2005.
(16) Loh LC, Abdul Samah SZ, Zainudin A, Wong GL, Gan WH, Yusuf WF, et al. Pulmonary disease empirically treated as tuberculosis-a retrospective study of 107 cases. Med J Malaysia 2005; 60: 62-70.
(17) Lee Ch, Kim W J, Yoo CG, Kim YW, Han SK, Shim YS, et al. Response to empirical anti-tuberculosis treatment in patients with sputum smear- negative presumptive pulmonary tuberculosis. Respiration 2000; 72: 369-74.
(18) Zumla A, Malon P, Henderson J, Grange JM. Impact of HIV infection on tuberculosis. Postgrad Med J 2000; 76: 259-68.
(19) Cabrera S, Medina J, Ortega V, Pérez G, Cappuccio P, Viola M, et al. Diagnóstico de linfadenitis tuberculosa en pacientes VIH: validación de la punción-aspiración con aguja fina. Resultados preliminares. Congreso de la Asociación Panamericana de Infectología, 12. Caracas, 15-18 de mayo 2005.
(20) García-Ordóñez MA, Colmenero JD, Jiménez-Onate F, Martos F, Martínez J, Juárez C. Diagnostic usefulness of percutaneus liver biopsy in HIV-infected patients with fever of unknown origin. J Infect 1999; 38: 94-8.
(21) Thambu David S, Mukundan U, Brahmadathan KN, Jacob John T. Detecting mycobacteraemia for diagnosing tuberculosis. Indian J Med 2004; 259-66.
(22) Bouza E, Diaz-Lopez MD, Moreno S, Bernaldo de Quiros JC, Vicente T, Berenguer J. Mycobacterium tuberculosis bacteremia in patients with and without human immunodeficiency virus infection. Arch Intern Med 1993; 153: 496-500.
(23) Supervia A, Knobel H, Perez-Vila E, Abella ME, Salvado M, Mellibovsky L, et al. Efficiency of bone marrow aspirate for diagnosis of opportunistic infections in HIV infected patients. An Med Interna 1996; 13: 374-7.
(24) Santos ES, Raez LE, Eckardt P, DeCesare T, Whitcomb CC, Byrne GE. The utility of a bone marrow biopsy in diagnosing the source of fever of unknown origin in patients with AIDS. J Acquir Immune Defic Syndr 2004; 37: 1599-603.
(25) Perlman DC, El-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, et al. Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. Clin Infect Dis 1997; 25: 242-6.
(26) Jasmer RM, Gotway MB, Creasman JM, Webb WR, Edinburgh KJ, Huang L. Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients. J Acquir Immune Defic Syndr 2002; 31: 291-8.
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Published
2007-09-30
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Cabrera SG, Medina JC, Salaberryborda AM, Librán MJ, González HM, Savio E. Difficulty in diagnosing tuberculosis in patients infected by the human immunodeficiency virus (HIV) and variables that determine the initiation of an empirical anti-tuberculosis treatment. Rev. Méd. Urug. [Internet]. 2007 Sep. 30 [cited 2024 Sep. 16];23(3):164-72. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/611
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