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Войти в исследования East African medical journal · 2000
Radiographic appearances of pulmonary tuberculosis in HIV-1 seropositive and seronegative adult patients.
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Kawooya V K, Kawooya M, Okwera A
Аннотация
OBJECTIVE: To describe the radiographic pattern of PTB in HIV-1 seropositive and seronegative patients and to study the relationship between radiographic pattern and degree of immunosuppression based on CD4 counts.
DESIGN: Cross-sectional, descriptive study.
SETTING: TB treatment centre and Department of Radiology, Mulago Referral Hospital and Makerere University Medical Teaching Hospital, Uganda.
SUBJECTS: One hundred and fifty consecutive adult patients, suspected on clinical grounds to have PTB.
INTERVENTIONS: Three early morning sputum specimens and 10 mls of venous blood taken from each qualifying subject.
MAIN OUTCOME MEASURES: Chest x-ray changes and CD4 counts.
RESULTS: More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderate to severely immunosuppressed, 27.2% were mildly immunosuppressed or had normal immune status. Approximately ninety three per cent of the seronegative individuals had normal immune status or were mildly immunosuppressed, while 6.4% were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7% of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3% and 41.3% respectively. Fibrosis and pleural effusion were observed in 25.0% and 25.3% respectively. Miliary disease occurred in 2.0%. Seropositives accounted for 81.5% and 76.3% of patients with lymphadenopathy and pleural effusion, 18.5% and 23.7% respectively were seronegative. Seronegatives accounted for 64.9% and 64.5% of those with fibrosis and cavitation respectively, whereas 35.1% 35.5% of fibrosis and cavitation respectively were seropositive. Patients who were moderate to severely immunosuppressed accounted for 64.6% and 63.2% of patients with lymphadenopathy and pleural effusion, 35.4% and 36.8% respectively had normal immune status or were mildly immunosuppressed. Fibrosis and cavitary disease were more frequent in normal or mildly immunosuppressed (78.4% and 72.6%) than in moderately to severely immunosuppressed patients (21.6% and 27.4%) (p<0.001).
CONCLUSION: HIV-seropositivity with moderate to severe immunesuppression are associated with atypical radiographic appearances in adult post primary PTB.
DESIGN: Cross-sectional, descriptive study.
SETTING: TB treatment centre and Department of Radiology, Mulago Referral Hospital and Makerere University Medical Teaching Hospital, Uganda.
SUBJECTS: One hundred and fifty consecutive adult patients, suspected on clinical grounds to have PTB.
INTERVENTIONS: Three early morning sputum specimens and 10 mls of venous blood taken from each qualifying subject.
MAIN OUTCOME MEASURES: Chest x-ray changes and CD4 counts.
RESULTS: More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderate to severely immunosuppressed, 27.2% were mildly immunosuppressed or had normal immune status. Approximately ninety three per cent of the seronegative individuals had normal immune status or were mildly immunosuppressed, while 6.4% were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7% of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3% and 41.3% respectively. Fibrosis and pleural effusion were observed in 25.0% and 25.3% respectively. Miliary disease occurred in 2.0%. Seropositives accounted for 81.5% and 76.3% of patients with lymphadenopathy and pleural effusion, 18.5% and 23.7% respectively were seronegative. Seronegatives accounted for 64.9% and 64.5% of those with fibrosis and cavitation respectively, whereas 35.1% 35.5% of fibrosis and cavitation respectively were seropositive. Patients who were moderate to severely immunosuppressed accounted for 64.6% and 63.2% of patients with lymphadenopathy and pleural effusion, 35.4% and 36.8% respectively had normal immune status or were mildly immunosuppressed. Fibrosis and cavitary disease were more frequent in normal or mildly immunosuppressed (78.4% and 72.6%) than in moderately to severely immunosuppressed patients (21.6% and 27.4%) (p<0.001).
CONCLUSION: HIV-seropositivity with moderate to severe immunesuppression are associated with atypical radiographic appearances in adult post primary PTB.