Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

Abstract

Objective: To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV. Methods: A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4 + T-cell counts, were obtained from medical records, and chest X-ray reports were consulted. Results: We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/ dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015). Conclusions: In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.Keywords: HIV; Tuberculosis; Acquired immunodeficiency syndrome. ResumoObjetivo: Comparar as manifestações clínicas, radiológicas e laboratoriais de indivíduos com tuberculose pulmonar coinfectados com HIV com aqueles sem a coinfecção. Métodos: Estudo transversal, no qual sinais e sintomas foram analisados por meio de anamnese e exame físico em pacientes internados com tuberculose pulmonar. A baciloscopia, a cultura para Mycobacterium tuberculosis, a dosagem de hemoglobina e a contagem de células T CD4 + foram obtidas de registros dos prontuários, assim como os laudos das radiografias de tórax. Resultados: Foram incluídos 50 pacientes com tuberculose pulmonar, que foram divididos em dois grupos (HIV positivo e HIV negativo; n = 25 por grupo). A média de idade dos participantes foi de 38,4 ± 10,5 anos, 46 (92%) eram do sexo masculino, e 27 (54%) eram caucasianos. Apresentaram expectoração 21 (84%) e 13 (52%) dos pacientes nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,016). Achados radiológicos de cavitação estavam presentes em 10 (43%) e 2 (10%) dos pacientes nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,016), ao passo que padrão intersticial estava presente em 18 (78%) e 8 (40%) dos pacientes nesses grupos (p = 0,012). O nível médio de hemoglobina foi de 11,1 ± 2,9 g/dL e 9,3 ± 2,2 g/dL nos grupos HIV negativo e HIV positivo, respectivamente (p = 0,015). Conclusões: Entre pacientes coinfectados com tuberculose e HIV desta amostra, houve me...

Association of CTLA4 Gene Polymorphisms with Susceptibility and Pathology Correlation to Pulmonary Tuberculosis in Southern Han Chinese

“…The adaptive immune system plays an important role in susceptibility to TB 8. Besen et al 19 compared the clinical, radiological, and laboratory characteristics of individuals with pulmonary TB co-infected or not with HIV and confirmed the importance of T lymphocyte in the immunopathogenesis of pulmonary TB. Our experiments indicate that CTLA4 SNPs are associated with pathological lung injury and susceptibility to pulmonary TB.…”

Avaliação dos riscos, mortalidade e qualidade de vida em pacientes com coinfecção Tuberculose/HIV

“…A interação entre as duas patologias resulta na aceleração do desenvolvimento de ambas as doenças. Nos indivíduos imunocompetentes, a chance de uma infecção por tuberculose evoluir para doença é de 10% ao longo da vida; nos infectados pelo HIV, a chance é de 8-10% a cada ano (BESEN A, et al, 2011;LIBERATO et al, 2004). Além disso, pacientes coinfectados com TB/HIV possuem uma menor quantidade de linfócitos CD4 e uma baixa qualidade de vida em comparação com pacientes infectados por HIV e que não apresentam a TB (JHA DK, et al, 2019).…”

“…Estudos indicam diferenças estatísticas no que tange aos achados clínicos, radiológicos e laboratoriais entre indivíduos HIV positivos e negativos, sendo nos pacientes HIV positivos a menor prevalência de expectoração, de imagem radiológica de cavitação e de lesão intersticial, assim como formas mais graves de anemia (BESEN A, et al, 2011;LIBERATO et al, 2004). Outrossim, o grau de imunossupressão pode atuar na apresentação clínica da tuberculose em coinfectados.…”

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system

“…The finding of 13.0% of cases with severe malnutrition may reflect the frequent consumptive nature of TB 20 . Malnutrition is associated with TB, both as a risk factor and a consequence of the illness.…”

“…Malnutrition is associated with TB, both as a risk factor and a consequence of the illness. The consumptive nature of TB is related to both, anorexia and increased production of inflammatory cytokines, which lead to a catabolic state 20 .…”