Identification of tuberculosis in patients of pulmonology department, including patients with HIV infection

Abstract

Objectives to define the possibilities of diagnosing tuberculosis in patients of pulmonology hospital, including patients with HIV infection.
 Material and methods. During this retrospective one-step study, we analyzed 103 medical records of patients in pulmonology departments who had received a full range of laboratory and instrumental examinations, including the Mantoux test and the test with a recombinant tuberculosis allergen (Diaskintest). The patients were divided into two groups depending on their HIV status: Group 1 included 78 HIV-negative patients, Group 2 consisted of 25 HIV-positive patients.
 Results. A microscopy of sputum and bronchial lavage did not reveal acid-resistant mycobacteria in all patients. PCR test for M. tb DNA was positive in three patients in Group 1 (33.3 13.9% of the total number of examined patients) and in one patient in Group 2 (25.0 13.9%) (2 = 0.01; p = 0.931). According to the results of immunodiagnostics, a positive normergic reaction to the Mantoux test was observed in 24 patients in Group 1 and in 7 patients in Group 2 (30.8 5.2% and 28.9 9.0% respectively), 2 = 0.04; p = 0.846. The reaction for recombinant tuberculosis allergen (Diaskintest) was positive in 9 patients in Group 1 (11.5 3.6%) and in 5 patients in Group 2 (20.0 8.0%), 2 = 0.85; p = 0.358. Based on clinical, laboratory, instrumental and immunological examinations by a TB doctor, in total 12 patients (11.7%) were diagnosed with tuberculosis. These patients were distributed among the study groups as follows: 9 people (11.5 3.6%) in Group 1 and 3 people (12.0 6.5%) in Group 2 (2 = 0.0; p = 0.956).
 Conclusion. The inclusion of the Mantoux test and the reaction for recombinant tuberculosis allergen (Diaskintest) in the set of diagnostic tests for patients of the pulmonology department of the general hospital simplified the differential diagnosis of tuberculosis and pneumonia, both for a pulmonologist and a TB specialist.