Miliary tuberculosis in human immunodeficiency virus infected patients not on antiretroviral therapy

Abstract

Background: An increase in tuberculosis (TB) incidence has been associated with human immunodeficiency virus (HIV). Aims: To describe the clinical characteristics and treatment outcome of patients with HIV and miliary TB treated with short-course intermittent chemotherapy in the absence of access to highly active antiretroviral therapy (HAART). Settings and Design: Prospective study of HIV infected adults referred to a TB clinic between July 1999 and July 2004. Materials and Methods: On diagnosis of miliary TB, patients were treated with a standard regimen of two months of isoniazid, rifampicin, ethambutol and pyrazinamide followed by four months of isoniazid and rifampicin (2EHRZ3 /4RH3) thrice weekly and followed up for 24 months. Patients were reviewed clinically every month and two sputa were collected. Chest radiographs and blood investigations were done at two months, end of treatment and every six months thereafter. Results: Of 498 patients with HIV and tuberculosis, 31 (6%) were diagnosed as miliary tuberculosis. At diagnosis, sputum smear was positive for acid-fast bacilli (AFB) in 14 patients (45%) and Mycobacterium tuberculosis was isolated in 21 (68%). The mean CD4 cell count was 129 ± 125 cells/mm3. Twenty-five patients were declared cured at the end of treatment (81%) while one (3%) died and five (16%) failed. The recurrence rate was 19.4/100 person-years and the median survival was 17 months (95% CI 14 to 20). None of the patients received antiretroviral therapy. Conclusions: Miliary TB tends to occur among HIV infected patients with severe immunosuppression. Though the initial response to short-course chemotherapy was encouraging, a high recurrence rate and mortality was observed indicating poor prognosis in HIV.

Miliary tuberculosis and acute respiratory distress syndrome

“…The case fatality rate in our hospital was 21%, which is higher than that reported from Senegal and Morocco [5], [6] but lower than that reported from Mali [4]. This high mortality rate could be explained by the delay in consultation, poor health resources, and impact of HIV infection [16]. Similar findings were reported from Burkina Faso [17].…”

Miliary tuberculosis: A new look at an old foe

“…However, since the 1980s a changing epidemiological trend has been observed and miliary TB is increasingly being recognized in adults also. Two peaks are evident, one involving adolescents, young adults and another later in life among elderly individuals [2], [3], [4], [5], [14], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50]. This epidemiological change has been thought to be due to global pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), increasing occurrence of organ transplantation, use of immunosuppressive drugs including anti-TNF-α, chronic hemodialysis program, among others.…”

“…In pediatric as well as adult series [2], [3], [4], [5], [14], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], male gender seems to be more frequently affected by miliary TB. In some adult series on miliary TB [14], [22], [34], [39] a female preponderance has been documented.…”

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital

“…A study carried out in India showed that 45% of HIV-positive patients with miliary TB had positive AFB smear sputum microscopy results and 61% had positive cultures; however, neither the number of samples, the type of sample (spontaneous or IS) nor the radiological findings were described. (25) This finding has a practical issue, if we consider these patients at a potential risk of transmitting the disease and therefore requiring isolation.…”