Comparative radiological features of disseminated disease due to Mycobacterium tuberculosis vs non-tuberculosismycobacteria among AIDS patients in Brazil

Abstract

BackgroundDisseminated mycobacterial disease is an important cause of morbidity and mortality in patients with HIV-infection. Nonspecific clinical presentation makes the diagnosis difficult and sometimes neglected.MethodsWe conducted a retrospective cohort study to compare the presentation of disseminated Mycobacterial tuberculosis (MTB) and non-tuberculous Mycobacterial (NTM) disease in HIV-positive patients from 1996 to 2006 in Brazil.ResultsTuberculosis (TB) was diagnosed in 65 patients (67.7%) and NTM in 31 (32.3%) patients. Patients with NTM had lower CD4 T cells counts (median 13.0 cells/mm3 versus 42.0 cells/mm3, P = 0.002). Patients with tuberculosis had significantly more positive acid-fast smears (48.0% vs 13.6%, P = 0.01). On chest X-ray, miliary infiltrate was only seen in patients with MTB (28.1% vs. 0.0%, P = 0.01). Pleural effusion was more common in patients with MTB (45.6% vs. 13.0%, P = 0.01). Abdominal adenopathy (73.1% vs. 33.3%, P = 0.003) and splenic hypoechoic nodules (38.5% vs. 0.0%, P = 0.002) were more common in patients with TB.ConclusionMiliary pulmonary pattern on X-ray, pleural effusion, abdominal adenopathy, and splenic hypoechoic nodules were imaging findings associated with the diagnosis of tuberculosis in HIV-infected patients. Recognition of these imaging features will help to distinguish TB from NTM in AIDS patients with fever of unknown origin due to disseminated mycobacterial disease.

Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review

“…Interpretation : Multiple hypoechoic lesions may represent small abscesses, which are frequently secondary to disseminated TB [19]. The image is characteristic and other differential diagnoses like other infections or disseminated malignancy are less likely.…”

Splenic granulomas: a rare manifestation of Mycobacterium avium complex in an immunocompetent host

“…These lesions are usually caused by M. tuberculosis infection and very rarely due to MAC 6. Splenic granulomas may be seen in association with disseminated MAC infections.…”

Update in Tuberculosis 2008

“…Nonspecific clinical presentation makes the diagnosis difficult. Santos and coworkers conducted a retrospective cohort study to compare the radiographic features of disseminated TB and nontuberculous mycobacterial disease in Brazil (28). Patients with nontuberculous mycobacterial disease had lower CD4 T-cell counts.…”