Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture

Bakari, Muhammad; Arbeit, Robert D.; Mtei, Lillian; Lyimo, Johnson; Waddell, Richard; Matee, Mecky; Cole, Bernard F.; Tvaroha, Susan; Horsburgh, C. Robert; Soini, Hanna; Pallangyo, Kisali; Reyn, C. Fordham von

doi:10.1186/1471-2334-8-32

Cited by 31 publications

(20 citation statements)

References 25 publications

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“…The tuberculous abscess is rare in non-HIV infections, accounting for only 4e8%, but the ratio could reach 20% in HIV infections. In this study, 4 cases of abscess lesions with ring-enhancement were documented, which echoed to the previous report [10]. In the cases with AIDS and concurrent brain infections, the toxoplasma encephalopathy showed an incidence just below that of the HIV encephalopathy incidence, which proved the major opportunistic infection of the nervous system in AIDS patients [11], especially those with CD4 þ T < 100 cells/mm 3 .…”

Section: Discussionsupporting

confidence: 84%

Application of diffusion tensor imaging in AIDS patients with brain opportunistic diseases: A comparative study of tuberculosis and toxoplasmosis

Chu

Zhao

et al. 2015

Radiology of Infectious Diseases

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Objective: This paper aims to discuss the diagnostic value of quantitative DTI on AIDS patients with brain tuberculosis or toxoplasmosis. Materials and methods: 22 subjects (12 with brain tuberculosis and 10 with toxoplasmosis) were recruited, who underwent routine MRI, T1WI-CE and DTI imaging sequence. The morphological characteristics of lesions were observed, and FA and ADC values of the solid areas, edematous areas and the contralateral normal areas of the lesions were calculated. Results were compared by one-way ANOVA and independent sample t-test. The TB diagnosis efficiency of these two values was analyzed by ROC curve. Results: ADC and FA values were detected with significant differences among the three regions between subjects with brain tuberculosis and subjects with toxoplasmosis (P < 0.05). Statistically significant difference was recorded between solid and edematous areas and contralateral areas in ADC and FA values (P < 0.05). And so was between the solid areas and edema areas in either group. Moreover, the FA values of the solid areas between two groups also presented statistically significant difference (P < 0.01). ROC curve of TB showed the AUC of FA value was larger than that of ADC value (0.914 vs. 0.715, respectively, P < 0.05). DTT imaging showed infiltrative changes of white matter fibers in the lesion areas. Conclusions: Quantitative DTI is valuable for diagnosis and differential diagnosis of patients with AIDS-associated infections, and also could provide references for clinical physicians for proper medications. The quantitative FA value could help better reveal different changes of microstructural integrity between different opportunistic infections.

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Section: Discussionsupporting

confidence: 84%

Application of diffusion tensor imaging in AIDS patients with brain opportunistic diseases: A comparative study of tuberculosis and toxoplasmosis

Chu

Zhao

et al. 2015

Radiology of Infectious Diseases

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“…A recent Ugandan study in HIV-infected patients starting ART revealed a high sensitivity and negative predictive value for the presence of several baseline factors (one of cough ≥ 3 weeks, fever ≥ 4 weeks, lymphadenopathy, or reduced body mass index) [21]; this study population had a much lower TB prevalence and included physical examination data that the current study did not. In the current study, the most sensitive strategies included a baseline CXR; the addition of baseline CXR to symptom screening and AFB smear has shown improved sensitivity of TB diagnosis in other African settings with high HIV prevalence [22, 23]. However, the most sensitive combinations of screening tools had very low specificity (15%), such that relying solely on tests available at baseline would lead to many patients being treated for TB who do not have the disease, incurring unnecessary toxicity and costs.…”

Section: Discussionmentioning

confidence: 99%

Intensive Tuberculosis Screening for HIV‐Infected Patients Starting Antiretroviral Therapy in Durban, South Africa

et al. 2010

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Background The World Health Organization (WHO) recommends cough as the trigger for tuberculosis (TB) screening in HIV-infected patients, with acid fast bacillus (AFB) smear as the initial diagnostic test. Our objective was to assess the yield and cost of a more intensive TB screening in HIV-infected patients starting antiretroviral therapy (ART) in Durban, South Africa. Methods We prospectively enrolled adults, regardless of TB signs/symptoms, undergoing pre-ART training from May ‘07–May ‘08. Following symptom screen, patients expectorated sputum for AFB smear, TB polymerase chain reaction (PCR), and mycobacterial culture. Sensitivity and specificity of different symptoms and tests, alone and in combination, were compared to a gold standard of 6-week TB culture results. Program costs included personnel, materials and cultures. Results Of 1,035 subjects, 487 (59%) were female; median CD4 count was 100/μl. Two-hundred and ten (20%) were receiving TB treatment and were excluded. Of the remaining 825 subjects, 158 (19%) had positive sputum cultures, of whom 14 (9%) had a positive AFB smear and 82 (52%) reported cough. The combination of cough, other symptoms, AFB smear, and chest x-ray had 93% (CI 88–97%) sensitivity and 15% (CI 13–18%) specificity. The incremental cost of intensive screening including culture was $360/additional TB case identified. Conclusions Nearly 20% of patients starting ART in Durban, South Africa had undiagnosed, culture-positive pulmonary TB. Despite WHO recommendations, neither cough nor AFB smear were adequately sensitive for screening. TB sputum cultures should be performed before ART initiation, regardless of symptoms, in areas of high HIV/TB prevalence.

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“…Such patients are more likely to have atypical radiographic findings including non-cavitary pulmonary infiltrates sparing the lung apices 85 86. One consequence of the lower frequency of pulmonary cavitation in HIV infection is that patients are more likely to have smear-negative pulmonary disease, although this is also the case for those with extrapulmonary TB 87 88. The value of tuberculin skin testing (TST) in patients with HIV is limited due to high false negative rates and in advanced immunosuppression a negative test does not exclude a diagnosis of TB 89…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Tuberculosis and the military

O’Shea

Wilson

2013

J R Army Med Corps

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Tuberculosis (TB) causes significant morbidity and mortality among the global civilian population. Historically, TB has also been responsible for a considerable burden of disease among military populations during periods of both peace and conflict. TB will continue to be of importance to the military for several reasons. Military units live and work in confined environments, personnel may deploy to areas highly endemic for TB where there is the potential to be exposed to infected local communities, and they undertake physiologically stressful activities during training and operations. These are just a few of the factors that may increase the risk of acquiring, developing and transmitting TB among military personnel. This review examines the military relevance of TB in the modern era within the context of epidemiological, pathological and clinical considerations of this ancient disease.

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Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture

Cited by 31 publications

References 25 publications

Application of diffusion tensor imaging in AIDS patients with brain opportunistic diseases: A comparative study of tuberculosis and toxoplasmosis

Application of diffusion tensor imaging in AIDS patients with brain opportunistic diseases: A comparative study of tuberculosis and toxoplasmosis

Intensive Tuberculosis Screening for HIV‐Infected Patients Starting Antiretroviral Therapy in Durban, South Africa

Tuberculosis and the military

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