Ocular disease in patients with tuberculosis and HIV presenting with fever in Africa

Abstract

Aims: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. Methods: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. Results: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. Conclusions: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.

Clinical characteristic and therapy results of presumed ocular tuberculosis and their relation to HIV status

“…[15][16][17][18][19] The presentation of granulomatous inflammation in HIV/AIDS patients in study are in accordance to several other studies which were mainly choroidal granulomas and tubercles. [20][21][22][23][24][25][26][27] Our findings that ocular TB in HIV/ AIDS patients all have systemic manifestation are in accordance to Babu et al study that found in HIV/ AIDS patients, all ocular TB patients have pulmonary TB, and among them two cases have coexistent central nervous system TB and one case had abdominal TB. In that study also found that the CD4+ cell counts ranged from 14 to 560 cells/µL with mean 160.85 cells/µL.…”

Ocular manifestations in HIV-AIDS patients in a Nigerian community

“…AIDS patients in developing countries. 13,14 Variation in the manifestation of ocular AIDS in developed and developing countries is presumed to be due to the early and high mortality rate in people living with HIV-AIDS in developing countries. This is coupled with differences in HIV subtype, race, as well as the influence of co-morbid diseases.…”

“…Most informed respondents had been enlightened by health workers (20, 55.6%). Few respondents (16,14.3%) had HIV-AIDS ocular manifestations. Squamous cell carcinoma was the most common ocular manifestation.…”

Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS

“…Published work is uneven and inconsistent, particularly with regard to Africa, 31,32,34,38,39 for reasons that remain unclear. Studies are diffi cult to compare because of diff erences in design, patient population, and reporting of HIV status.…”

“…Two studies 34,35 specifi cally address choroidal tuberculosis in patients later discovered to have bacteraemia because of Mycobacterium tuberculosis: lesions were identifi ed in three (5·7%) of 53 consecutive patients admitted to a hospital in Malawi because of fever 34 and in fi ve (50%) of ten patients who were in an intensive care unit in a hospital in India. 35 Mycobacteraemia was fi rst reported in patients with AIDS in 1986, 55 and is associated with low CD4 counts, disseminated infection, severe disease, and high mortality, 56 including a report from Tanzania of 50% mortality in 36 days.…”