Factors Associated with Negative Direct Sputum Examination in Asian and African HIV-Infected Patients with Tuberculosis (ANRS 1260)

Abstract

ObjectiveTo identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV.DesignProspective multicenter study (ANRS1260) conducted in Cambodia, Senegal and Central African Republic.MethodsUnivariate and multivariate analyses (logistic regression) were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium.ResultsBetween September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB) examination was positive in sputum samples from 110 subjects (63%) and negative in 65 patients (37%). Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification) with a median CD4 cell count of 36/mm3. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1–7.0]), dyspnea (OR = 2.5 [95%CI:1.1–5.6]), and localized interstitial opacities (OR = 3.1 [95%CI:1.3–7.6]), but was less frequent with CD4≤50/mm3 (OR = 0.4 [95%CI:0.2–0.90), adenopathies (OR = 0.4 [95%CI:0.2–0.93]) and cavitation (OR = 0.1 [95%CI:0.03–0.6]).ConclusionsOne novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical features (without cavitation) and high pulmonary mycobacterial burden.

Traditional Herbal Remedies with a Multifunctional Therapeutic Approach as an Implication in COVID-19 Associated Co-Infections

“…In this study, 120 sputum samples were collected, out of which 85 (70.83%) patients showed a positive incidence for different bacterial and fungal pathogens, which included S. aureus, Pseudomonas aeruginosa, and Candida spp., and were also reported by [41]. All samples were non-AFB sputum samples but also showed the presence of other pathogens, which has been already confirmed in a Cambodian study by [42]. Hence, it was concluded from the study that the sputum samples that were negative for AFB also showed the incidence of pathogenic bacterial isolates such as Escherichia coli, Pseudomonas aeruginosa, Moraxella catarrhalis, Staphylococcus aureus, Serratia spp., Enterobacter spp., and Candida spp.…”

Inverse Relationship of Serum Hepcidin Levels with CD4 Cell Counts in HIV-Infected Patients Selected from an Indonesian Prospective Cohort Study

“…First, in more than 50% in all cases there was no culture confirmation of TB. Unfortunately, it is well known that sputum microscopy and culture both suffer from decreased sensitivity in HIV-infected individuals [38] , [39] . We like to point out that we only included patients with bacteriological proof or clinical and radiological signs of tuberculosis, plus a positive treatment response.…”

Comparison of 3 diagnostic methods for pulmonary tuberculosis in suspected patients with negative sputum smear or no sputum

“…[ 16 , 17 ] A concurrent respiratory infection was reported to be associated with negative AFB. [ 18 ] The presence of a pulmonary cavity, age, and a positive interferon-γ release assay could predict positive BALF-AFB in sputum smear-negative patients. [ 19 ] Hence, several factors appear to influence the positivity of BALF-AFB.…”