High prevalence of tuberculosis in AIDS patients in Spain

Abstract

A total of 67 cases of tuberculosis was diagnosed in the first 100 cases of AIDS, diagnosed according to the former CDC criteria, at a hospital in Madrid, Spain. This is the highest known prevalence of tuberculosis in AIDS patients both within and outside Spain. The clinical manifestations of tuberculosis were very variable and atypical. The rate of isolation of Mycobacterium tuberculosis from blood was particularly high: of 25 patients in whom blood cultures were performed, 16 were positive. In a third of the patients with proven mycobacteremia, blood was the first or the only positive specimen. In general, therapy resulted in rapid clinical improvement, but in some cases mycobacteria were isolated from clinical or necroscopy specimens months after what was considered adequate therapy.

Abdominal ultrasound findings of disseminated tuberculosis in AIDS

“…2 Extrapulmonary tuberculosis occurs more frequently in geographic areas where the prevalence of tuberculosis in the general population is higher, as in Spain. 3 The diagnosis of disseminated tuberculosis is difficult to establish in many cases in spite of the involvement of many organs: the Mantoux test is rarely positive, and in only 25% of cases was a positive sputum for acid-fast bacilli (AFB) obtained. 4 A chest x-ray often does not suggest tuberculosis; the diagnosis of M. tuberculosis infection can only be inferred when chest x-rays show a miliary pattern (30% of patients in our study).…”

Diagnóstico de la infección micobacteriana diseminada: evaluación de un método sencillo y barato para países en desarrollo

“…Por consiguiente, estos datos concuerdan con los de Bouza et al (10), aunque se contraponen con los de Shafer et al (6), para los cuales esta técnica no fue útil para diagnosticar la tuberculosis. El complejo M. avium es el causante de la infección bacteriana más frecuente en pacientes de sida en los Estados Unidos y Europa (3,8), si bien prácticamente se desconoce su frecuencia en los países en desarrollo (11).…”

Mycobacterial Infections in AIDS

“…Disseminated M avium complex infection predominates in most centres in North America and is more uniform in geographic distribution than is M avium complex lung disease unrelated to HN (20) . TB is more commonly recognized (and appears to be more prevalent) in many regions of the world, particularly in developing nations where the majority of persons have been infected by adulthood, and are thus at risk for reactivated disease (7,(21)(22)(23)(24)(25)(26). The reason for the low frequency of diagnosed M avium complex infection in some countries remains unclear.…”

“…With more advanced immunodeficiency, the infection is no longer contained locally: regional or disseminated lymphadenopathy, extrapulmonary foci and cutaneous anergy become characteristic. Lymphohematogenous dissemination is probably routine in patients with clinical AIDS, as indicated by the yield ofblood culture (25,37,59,60).…”

“…(24) White (non-Hispanic) Hispanic Black (no n-Haitian) Haitian San Francisco , C alifornia ( 15) Port-au-Prince. Haiti (7) Rio de Janiero, Brazil ( 100) Spain (26) Madrid , Spain (25) Epidemiological understanding of M avium complex infection in AJDS is incomplete. It is generally assumed, as in non-AJDS cases, that bacteria are acquired from environmental sources and that disease follows recent rather than remote infection (17,20) .…”