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

Abstract

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...

Características Epidemiológicas dos Casos Notificados de Tuberculose-HIV tratados em Hospital de Referência da Paraíba, 2005 - 2011

“…A infecção por HIV pode modificar a apresentação clínica da tuberculose, a duração do tratamento, a tolerância e a resistência aÌs drogas disponíveis e, possivelmente, a suscetibilidade dos comunicantes envolvidos, principalmente nos estados avançados de comprometimento imunológico 8,9,12,26 . Além da clínica, o impacto socioeconômico e emocional é maior na coinfecção, repercutindo na qualidade de vida, que por vezes já se encontra vulnerável pela situação de marginalidade e empobrecimento a qual está submetido os segmentos da sociedade mais acometidos 9,12,13,17 .…”

Aspects radiologiques des séquelles de tuberculose thoracique de l’adulte au service de pneumo-phtisiologie de l’hôpital national Ignace Deen

“…Il y avait 61 hommes (59,2 %) soit un sexratio de 1,45 (figure 1). [16,17,18] confirmant l'affirmation de Lacombe [19] qui disait plutôt que lors de la coïnfection VIH/TB et surtout lorsque le taux des CD4 est inférieur à 200/mm3 la prédominance des lésions apicales étaient moins prononcés. La radiographie pulmonaire est un outil clé dans le diagnostic des pathologies thoraciques notamment la tuberculose [20].…”