HIV Infection and Malnutrition Change the Clinical and Radiological Features of Pulmonary Tuberculosis

Abstract

Patients with HIV infection have atypical clinical features of pulmonary tuberculosis; however, our knowledge on how malnutrition affects the clinical presentation is limited. We studied the influence of malnutrition and HIV infection on the clinical and radiological features of pulmonary tuberculosis (TB). We studied 239 consecutive acid fast bacillus-positive adult patients. Patients were investigated by clinical, radiological, anthropometric and laboratory methods. 78% of the patients were malnourished (BMI < 18.5) and 43% were severely malnourished (BMI < 16). 20% were HIV-positive. HIV-positive TB had significantly more oral candidiasis (OR = 3.72), diarrhoea (OR = 2.71), generalized lymphadenopathy (OR = 2.63), skin disorders (OR = 2.27), neuropsychiatric illness (OR = 2.44), hilar lymphadenopathy (OR = 2.07), but less cavitation (OR = 0.64) and upper lung lobe involvement (OR = 0.70). HIV-negative and severe malnourished patients presented more often with dyspnoea (OR = 1.44), diarrhoea (OR = 1.64), night sweat (OR = 1.83), and less with haemoptysis (OR = 0.58) and cavitation (OR = 0.64). The size of Mantoux was associated with HIV infection and malnutrition. In a logistic regression analysis both HIV status and malnutrition were associated with atypical presentation of pulmonary tuberculosis. Malnutrition and HIV infection both contribute for atypical presentation of pulmonary tuberculosis. The risk of such atypical presentation is particularly high among the severely malnourished HIV-infected patients.

Microscopic examination and smear negative pulmonary tuberculosis in Ethiopia

“…This result was smaller than the findings of Gellete et al, 1997 (44.4%) [22] in Shashamene General Hospital, Southern Ethiopia and Demisse et al, 2001 (45.3%) [23] in Addis Ababa. However, it was larger than 20.5% and 22% incidences which were reported by Madebo et al, (1997) [24] in Yirga Alem Hospital in Southern Ethiopia and Mitike et al, (1997) [25] in Harrar Hospital in Eastern Ethiopia, respectively. Low sensitivity of microscopic examination together with the advent of HIV/AIDS increased the prevalence of smear negative pulmonary TB.…”

Tuberculosis and nutrition

“…Two studies in Haiti and England showed significant difference between arm muscle circumference in adults with tuberculosis and healthy controls 60. Mid-upper arm circumference was significantly lower among HIV positive adults with tuberculosis than in HIV negative adults with tuberculosis 26. Mean triceps skin fold thickness is also lower in HIV positive adults with tuberculosis than in HIV negative adults with tuberculosis 60…”

Triple Trouble: the Role of Malnutrition in Tuberculosis and Human Immunodeficiency Virus Co-infection

“…Undernutrition is often de ned as a having a body mass index (BMI kg/m 2 ) of 18.5. 78 Several studies have shown that BMI is lower in adults with pulmonary tuberculosis than in healthy controls (Table 3), 72,73,76,79 and that BMI is lower in HIV-infected adults with tuberculosis than in HIV-negative adults with tuberculosis (Table 4). 5,7,63,80 In Uganda, no difference was found in BMI between HIV-positive and HIV-negative adults with pulmonary tuberculosis.…”

“…73,74 Mid-upper arm circumference (MUAC) was signi cantly lower among adults with pulmonary tuberculosis than in healthy controls, and was signi cantly lower among HIV-positive adults with tuberculosis than in HIV-negative adults with tuberculosis. 5,74,79,82 A mean MUAC of 19.5 2.6 cm was reported among 239 HIV-infected adults with tuberculosis in Ethiopia. 79 Mean triceps skin- fold thickness is also lower in adults with pulmonary tuberculosis than in healthy controls, and in HIV-positive adults with tuberculosis than in HIV-negative adults with tuberculosis.…”