Interpretation of chest radiographs in AIDS patients: usefulness of CD4 lymphocyte counts.

Shah, Rosita M.; Kaji, Ayumi; Ostrum, Bernard J.; Friedman, Adie

doi:10.1148/radiographics.17.1.9017798

Cited by 49 publications

(27 citation statements)

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“…For the hospitalised patients with advanced AIDS who were included in our study, immediate diagnosis and treatment are crucial in preventing deaths and the CXR has a crucial role in guiding management. Our findings confirm the atypical pattern of pulmonary TB in HIV-seropositive patients with low CD4+ T-cell counts, most importantly the absence of cavities [4,8,13,[21][22][23][24][25][26]. Our finding that consolidation was more common in the HIV-seronegative patient group corresponds with one prior study [6].…”

Section: Discussionsupporting

confidence: 87%

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Kisembo¹,

Boon²,

Davis³

et al. 2012

BJR

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Objective: We describe chest radiograph (CXR) findings in a population with a high prevalence of human immunodeficiency virus (HIV) and tuberculosis (TB) in order to identify radiological features associated with TB; to compare CXR features between HIV-seronegative and HIV-seropositive patients with TB; and to correlate CXR findings with CD4 T-cell count. Methods: Consecutive adult patients admitted to a national referral hospital with a cough of duration of 2 weeks or longer underwent diagnostic evaluation for TB and other pneumonias, including sputum examination and mycobacterial culture, bronchoscopy and CXR. Two radiologists blindly reviewed CXRs using a standardised interpretation form. Results: Smear or culture-positive TB was diagnosed in 214 of 403 (53%) patients. Median CD4+ T-cell count was 50 cells mm -3 [interquartile range (IQR) 14-150]. TB patients were less likely than non-TB patients to have a normal CXR (12% vs 20%, p50.04), and more likely than non-TB patients to have a diffuse pattern of opacities (75% vs 60%, p50.003), reticulonodular opacities (45% vs 12%, p,0.001), nodules (14% vs 6%, p50.008) or cavities (18% vs 7%, p50.001). HIV-seronegative TB patients more often had consolidation (70% vs 42%, p50.007) and cavities (48% vs 13%, p,0.001) than HIV-seropositive TB patients. TB patients with a CD4+ T-cell count of #50 cells mm -3 less often had consolidation (33% vs 54%, p50.006) and more often had hilar lymphadenopathy (30% vs 16%, p50.03) compared with patients with CD4 51-200 cells mm -3 . Conclusion: Although different CXR patterns can be seen in TB and non-TB pneumonias there is considerable overlap in features, especially among HIVseropositive and severely immunosuppressed patients. Providing clinical and immunological information to the radiologist might improve the accuracy of radiographic diagnosis of TB.

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Section: Discussionsupporting

confidence: 87%

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Kisembo¹,

Boon²,

Davis³

et al. 2012

BJR

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“…Além da antibioticoterapia, é indicada a ressecção cirúrgica de tecido necrótico, drenagem de lesões supurativas e controle de fatores predisponentes (1,9) . Por fim, a infecção por R. equi deve ser suspeitada em todo paciente imunodeprimido ou HIV positivo com pneumonia lentamente evolutiva, especialmente em presença de necrose tecidual e em pacientes com CD4 entre 50 e 200 células (20) . …”

Section: Figura 4 -Caso 2: Controle Radiológico (Jan/98) Após Términunclassified

Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros

Severo¹,

Ritter

Petrillo

et al. 2001

J. Pneumologia

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O Rhodococcus equi, principal agente da rodococose, é um cocobacilo pleomórfico, gram-positivo e aeróbio, que infecta humanos por via inalatória ou transcutânea e se manifesta clinicamente como abscesso pulmonar. Relatam-se os dois primeiros casos brasileiros da doença. Ambos os pacientes eram imunocomprometidos e apresentavam quadro infeccioso pulmonar. O primeiro tinha AIDS e apresentava pneumonia cavitada em lobo superior esquerdo, que teve evolução fatal. O segundo tinha doença de Goodpasture, insuficiência renal crônica e fazia uso de corticosteróides. Apresentava uma lesão pulmonar escavada no lobo superior direito, que foi tratada com sulfametoxazol-trimetoprim, com resolução do processo. (J Pneumol 2001;27(3):158-162) Pulmonary Rhodococcus equi infection: report of the first two Brazilian cases Rhodococcus equi, the principal agent of rhodococcosis, is a pleomorphic, gram-positive, aerobic coccus bacillus that infects humans by inhalation or through a transcutaneous route. It is

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“…The differences found in the presentation of TB in HIV-positive patients are due to cellular immunodeficiency secondary to the progressive destruction of CD4 lymphocytes by HIV, (4,6,9,10) and the tuberculous lesions can result from the reactivation of old foci or from re-infection. (4,6,8) Therefore, CD4 counts in peripheral blood are used to evaluate the immunological status of patients infected with the virus, and the counts thus obtained can be correlated with the clinical and radiological presentation of TB.…”

Section: Introductionmentioning

confidence: 99%

“…(4,6,8) Therefore, CD4 counts in peripheral blood are used to evaluate the immunological status of patients infected with the virus, and the counts thus obtained can be correlated with the clinical and radiological presentation of TB. (3,(6)(7)(8)(9)(10)(11)(12) When TB manifests in HIV-positive patients with relatively preserved immunity (CD4 > 350 cells/mm 3 ), the clinical and radiological presentation is similar to that seen in individuals who are not infected with HIV (HIV-negative individuals). (6) In patients with low CD4 counts, especially lower than 200 cell/mm 3 , TB can have an atypical presentation.…”

Section: Introductionmentioning

confidence: 99%

“…(6) In patients with low CD4 counts, especially lower than 200 cell/mm 3 , TB can have an atypical presentation. (3,(6)(7)(8)(9)(10)(11) The objective of the present study was to describe the differences in the clinical and radiological presentation of intrathoracic TB in HIV-positive and HIV-negative patients, as well as to determine the correlation between CD4 lymphocyte counts and the presence of atypical forms of TB in HIV-positive patients living in an area of high prevalence of TB/ HIV co-infection.…”

Section: Introductionmentioning

confidence: 99%

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Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

et al. 2007

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Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. tive sputum smear microscopy; having undergone HIV testing; and having undergone simple anteroposterior and lateral chest X-ray.The data were obtained through the re-evaluation of chest X-rays and the review of medical charts. The variables analyzed were as follows: age; gender; alcoholism; use of illicit drugs; corticosteroid use; duration of symptoms; presence of multifocal disease, diabetes mellitus, neoplasias, and opportunistic diseases; results of HIV testing; number of CD4 T lymphocytes; and radiological findings.Sputum smear microscopy was performed using the Ziehl-Neelsen technique. The HIV testing was performed using the ELISA method, and positive results were confirmed by Western blot. The CD4 counts were obtained using flow cytometry. Alcoholism and drug addiction were considered present when they had been registered on the medical chart by the treatment team. Multifocal disease was defined by the presence of superficial lymph node enlargement in patients with pulmonary TB.The chest X-rays were independently evaluated by two radiologists, who had no knowledge of the results of HIV testing, in order to identify the types of TB; the location of the lesions in the lung segments; and the presence of cavitary lesions, hilar or mediastinal lymph node enlargement, and pleural effusion. In case of inconsistency between the evaluations, the chest X-rays were jointly examined and, in the event of the inconsistency persisting, a third radiologist was consulted so that a consensus could be reached. The types of TB were characterized using the following classification: 1) Classic pulmonary TB: pulmonary lesions unaccompanied by hilar or mediastinal lymph node enlargement; 2) Tuberculous pneumonia: homogeneous consolidation with air bronchograms, with or without intrathoracic lymph node enlargement; 3) Hematogenous TB: diffuse pulmonar...

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Interpretation of chest radiographs in AIDS patients: usefulness of CD4 lymphocyte counts.

Abstract: Recipient of a Cum Laude award for a scientific exhibit at the 1994 RSNA scientific assembly.

Cited by 49 publications

References 0 publications

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Chest radiographic findings of pulmonary tuberculosis in severely immunocompromised patients with the human immunodeficiency virus

Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

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