Disseminated Tuberculosis in the Acquired Immunodeficiency Syndrome Era

Abstract

To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987. Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1). A total of 20 had TB unrelated to HIV disease (Group 2). The remaining 12 were excluded because the role of HIV could not be determined. Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03). Chest radiographs showed a miliary pattern in about half of each group. Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group. Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1. Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01). Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli. HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Mycobacterium tuberculosis enhances human immunodeficiency virus-1 replication by transcriptional activation at the long terminal repeat.

“…HIV-1 infected individuals have a high likelihood of developing progressive pulmonary and/or extrapulmonary tuberculosis upon new infection with M. tuberculosis. (8,9). Tuberculosis has recently been added to the case definition of AIDS.…”

“…Tuberculosis may well accelerate the course of HIV infection (8,11,12). Mortality of dually infected HIV/tuberculosis individuals has been reported to be as high as 50% at 12 mo in New York compared to < 10% due to M. tuberculosis alone, and mortality among HIV-1-infected individuals with multidrug-resistant M. tuberculosis can be as high as 90% at 9 mo (13).…”

Miliary tuberculosis: a comparison of CT findings in HIV-seropositive and HIV-seronegative patients

“…In 2005, the World Health Organization estimated that 12% of HIV deaths globally were caused by TB, and that there were 630 000 new coinfections with TB and HIV [5]. Disseminated TB accounted for 5.4-8.1% of culture-confirmed TB cases, with 10-14% of patients coinfected with HIV having clinically recognisable dissemination [6,7].…”

Tuberculosis en pacientes ancianos: Formas de presentación

“…En estas formas, al igual que otros autores y tal como hemos realizado en anteriores ocasiones (32,42), se incluyen aquellos casos de más de una localización extrapulmonar con el fin de separarlos de aquellos considerados como tuberculosis miliar. Como resumen de los expuesto, comentamos que las formas pulmonares han sido las más frecuentemente registradas.…”