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Generalized tuberculosis in HIV-infected patients with AIDS
© Zimina et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Purpose of the study
To estimate peculiarities of diagnosis and clinical course of generalized TB in HIV patients with AIDS who received treatment in TB Hospital #7, Moscow in 2006-2009.
94 cases (47,9%) of generalized TB have been analyzed. Most of them are men (82,9%), the mean age of the patients being 31,2±7,02. The average period from HIV detection to TB diagnosis is 5,7±2,96 years.
In 62 cases (66%) the clinical TB symptomatology developed quite fast, in 2,2±1,9 months on average. An acute beginning was seen in 32 cases (34%). 44 patients (46,8%) had both TB and other secondary diseases. The CD4 lymphocyte mean level was 91 cells/mm3. M. tuberculosis was found in 52 cases (55,3%): in the sputum analyses of 26 patients (27,7%) and in 26 more analyses of other biological materials (such as exudates, urine, feces, liquor, bioptic and surgical material). Among 29 patients tested for TB drug resistance 13 (44,8%) proved to be multidrug-resistant TB cases. The chest X-ray examination showed intrathoracic lymphoadenopathy in 68,1% cases, interstitial dissemination in 29,7% cases and only 7,5% cases revealed disintegration of tissue. 77 patients (81,9%) underwent different surgical interventions for the purpose of diagnosis or treatment, namely: diagnostic laparoscopy (16 cases), curative laparotomy (22), mediastinoscopy with intrathoracic lymph node biopsy (4), pleura biopsy (9), debridement of a peripheral lymph node (17), pericardial microdrainage (6), pleural cavity drainage (2), orchectomy (1). While examining the received diagnostic material morphological markers of TB inflammation were found in 56 cases (59,6%). Among most often discovered extrapulmonary localizations are abdominal involvement (53,3%), nodal involvement (27,7%), meningoencephalitis (15,9%), pericarditis (15,9%). Involvement of more than 3 systems was diagnosed in 25 patients (26,6%). Specific TB treatment included 4 to 6 drugs, the follow-up period for complete treatment was 6 months. Treatment results: cured - 36 cases (38,3%), defaulters - 34 cases (36,1%), died - 24 cases (25,5%).
Thus, providing treatment and diagnosis to patients with multiple-localization TB is complicated and requires an interdisciplinary approach including different surgical methods of diagnosis and treatment. The CD4 lymphocyte level lower than 100 cells/mm3 before treatment increases significantly the probability of an unfavorable outcome of generalized TB.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.