Clinical Presentation of Tuberculosis and the Degree of Immunodeficiency in Patients with HIV Infection

Abstract

A retrospective study of 80 HIV patients diagnosed with tuberculosis was carried out in order to evaluate the clinical presentation of tuberculosis (CPT) in relation to the degree of HIV-induced immunodeficiency, as determined by the CD4 lymphocyte count and reactivity to the tuberculin and delayed-type hypersensitivity reaction (DHR) skin tests by applying 2TU of RT-23 tuberculin, and the Muiltest IMC Merieux, respectively. CPT classification was undertaken on the basis of the location of the disease: pulmonary tuberculosis (PT), distinguishing between typical pulmonary (TP) and atypical (AP) according to the radiological pattern; extrapulmonary (ET); mixed tuberculosis (MT) pulmonary and extrapulmonary; and miliary tuberculosis. The CD4 lymphocyte count was 264.6 +/- 226.8, the TP had the highest number (505), MT had 132 (p < 0.001) and the miliary tuberculosis had 148 (p < 0.001), the lowest. The tuberculin skin test was positive in 35%, of which 11% were MT (p < 0.05). In the delayed-type hypersensitivity reaction, 67% were non-normoergic, of which 95% and 100% were MT and miliary tuberculosis, respectively (p < 0.05). There was a good overlap between CD4 depletion and skin tests. TP exhibited moderate immunodeficiency, AP severe immunodeficiency, and mixed and miliary TB extremely high immunodeficiency.

Prevalence and Its Predictors of Extrapulmonary Involvement in Patients with Pulmonary Tuberculosis

“…Considering that various types of impaired cell-mediated immunity have been considered to play an important role in the development of EPTB (10, 19-22), the decreased host immunity suggested by the presence of bilateral lung involvement could be crucial in the dissemination of tuberculous bacilli to extrapulmonary organs. In fact, pulmonary TB patients on immunosuppressants were prone to have extrapulmonary involvement ( p =0.08) in this study, although we failed to get statistical significance because of the small numbers of patients on immunosuppressants.…”

“…Extrapulmonary organ involvement (10) in human immunodeficiency virus (HIV)-infected patients with pulmonary TB is reported to be 26%, however, the clinical characteristics of patients with pulmonary TB at risk of simultaneous extrapulmonary organ involvement have not been studied in detail, although the initiation of treatment following early identification of extrapulmonary involvement is crucial. The aim of this study was to determine the prevalence and clinical predictors of the presence of extrapulmonary involvement in patients with pulmonary TB.…”

The bacterial and host factors associated with extrapulmonary dissemination of Mycobacterium tuberculosis

“…In HIV-positive patients, however, EPTB cases increased dramatically to more than 50% of all cases of TB (Theuer et al, 1990; Shafer et al, 1991; Haas and Des Prez, 1994; Antonucci et al, 1995; Lado Lado et al, 1999; Lee et al, 2000; Yang et al, 2004). We found the risk of developing EPTB in HIV positive patients is as high as 5-fold of that in HIV negative patients, after controlling age, race, and gender (Yang et al, 2004).…”

The Relationship Between the Opportunistic Diseases and Viral Load and CD4+ T Cell Count in Patients With HIV Infection

“…Bu çalışmada tü-berküloz gelişen olgularda CD4 + T hücre sayısının 6-725 hücre/ mm 3 arasında değişmekte olması tüberküloz gelişiminde CD4 + T hücre sayısının güvenilir bir parametre olmadığını göster-miştir. Bunun yanında bazı çalışmalarda CD4 + T hücre sayısı düştükçe, akciğer dışı tutulum sıklığının arttığı tespit edilmiştir (29). Bu çalışmada da CD4 + T hücre düzeyi yüksek olan hastalarda bile akciğer tüberkülozu mevcutken, akciğer dışı tüberkü-loz daha düşük düzeylerde saptanmıştır.…”