High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania

被引:155
作者
Mtei, L
Matee, M
Herfort, O
Bakari, M
Horsburgh, CR
Waddell, R
Cole, BF
Vuola, JM
Tvaroha, S
Kreiswirth, B
Pallangyo, K
von Reyn, CF
机构
[1] Muhimbili Univ Coll Hlth Sci, Dar Es Salaam, Tanzania
[2] Dartmouth Hitchcock Med Ctr, Infect Dis Sect, Lebanon, NH 03766 USA
[3] Dartmouth Hitchcock Med Ctr, Dept Community & Family Med, Lebanon, NH 03766 USA
[4] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
[5] Publ Hlth Res Inst, Newark, NJ USA
[6] Natl Publ Hlth Inst, Dept Vaccines, Helsinki, Finland
关键词
D O I
10.1086/429825
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. We sought to determine the prevalence of active tuberculosis among ambulatory HIV-infected persons in Tanzania with CD4 cell counts of >= 200 cells/mm(3) and a bacille Calmette-Guerin vaccination scar. Methods. Subjects who volunteered for a tuberculosis booster vaccine trial were screened for active tuberculosis by obtainment of a history, physical examination, chest radiography, sputum culture and acid fast bacillus (AFB) stain, and blood culture. All subjects underwent a tuberculin skin test (TST) and lymphocyte proliferation assays (LPAs) for detection of responses to mycobacterial antigens. Results. Active tuberculosis was identified at baseline in 14 (15%) of the first 93 subjects who were enrolled: 10 (71%) had clinical tuberculosis (symptoms or chest radiograph findings), and 4 (29%) had subclinical tuberculosis (positive sputum AFB stain or culture results but no symptoms or chest radiograph findings). An additional 6 subjects with subclinical tuberculosis were identified subsequently. The 10 subjects with subclinical tuberculosis included 3 with positive sputum AFB stains results and 7 who were only identified by a positive sputum culture result. Compared with subjects who did not have tuberculosis, the 10 subjects with subclinical tuberculosis were more likely to have peripheral lymphadenopathy, positive TST results, and elevated LPA responses to early secreted antigenic target 6 (ESAT). Eight of 10 patients had received isoniazid because of a positive TST result before active tuberculosis was recognized. Conclusions. Clinical and subchnical tuberculosis are common among ambulatory HIV-infected persons, and some cases can only be identified by sputum culture. World Health Organization guidelines for screening for latent tuberculosis before treatment do not recommend sputum culture and, therefore, may fail to identify a substantial number of HIV-infected persons with subclinical, active tuberculosis.
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收藏
页码:1500 / 1507
页数:8
相关论文
共 28 条
  • [11] Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1
    Harries, AD
    Hargreaves, NJ
    Kemp, J
    Jindani, A
    Enarson, DA
    Maher, D
    Salaniponi, FM
    [J]. LANCET, 2001, 357 (9267) : 1519 - 1523
  • [12] Duration of efficacy of treatment of latent tuberculosis infection in HIV infected adults
    Johnson, JL
    Okwera, A
    Hom, DL
    Mayanja, H
    Kityo, CM
    Nsubuga, P
    Nakibali, JG
    Loughlin, AM
    Yun, H
    Mugyenyi, PN
    Vernon, A
    Mugerwa, RD
    Ellner, JJ
    Whalen, CC
    [J]. AIDS, 2001, 15 (16) : 2137 - 2147
  • [13] RELATIONSHIP OF THE MANIFESTATIONS OF TUBERCULOSIS TO CD4 CELL COUNTS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION
    JONES, BE
    YOUNG, SMM
    ANTONISKIS, D
    DAVIDSON, PT
    KRAMER, F
    BARNES, PF
    [J]. AMERICAN REVIEW OF RESPIRATORY DISEASE, 1993, 148 (05): : 1292 - 1297
  • [14] TUBERCULIN CONVERSION - ICEBERG OF TUCERCULOUS PATHOGENESIS
    KENT, DC
    REID, D
    SOKOLOWSKI, JW
    HOUK, VN
    [J]. ARCHIVES OF ENVIRONMENTAL HEALTH, 1967, 14 (04): : 580 - +
  • [15] Kimerling ME, 2002, INT J TUBERC LUNG D, V6, P988
  • [16] Value of chest radiography in a tuberculosis prevention programme for HIV-infected people, Botswana
    Mosimaneotsile, B
    Talbot, EA
    Moeti, TL
    Hone, NM
    Moalosi, G
    Moffat, HJ
    Lee, EJ
    Kenyon, TA
    [J]. LANCET, 2003, 362 (9395) : 1551 - 1552
  • [17] Twice weekly tuberculosis preventive therapy in HIV infection in Zambia
    Mwinga, A
    Hosp, M
    Godfrey-Faussett, P
    Quigley, M
    Mwaba, P
    Mugala, BN
    Nyirenda, O
    Luo, N
    Pobee, J
    Elliott, AM
    McAdam, KPWJ
    Porter, JDH
    [J]. AIDS, 1998, 12 (18) : 2447 - 2457
  • [18] Tuberculosis active case-finding in a mother-to-child HIV transmission prevention programme in Soweto, South Africa
    Nachega, J
    Coetzee, J
    Adendorff, T
    Msandiwa, R
    Gray, GE
    McIntyre, JA
    Chaisson, RE
    [J]. AIDS, 2003, 17 (09) : 1398 - 1400
  • [19] IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS ON TUBERCULOSIS IN DEVELOPING-COUNTRIES
    NUNN, PP
    ELLIOTT, AM
    MCADAM, KPWJ
    [J]. THORAX, 1994, 49 (05) : 511 - 518
  • [20] Direct ex vivo analysis of antigen-specific IFN-γ-secreting CD4 T cells in Mycobacterium tuberculosis-infected individuals:: Associations with clinical disease state and effect of treatment
    Pathan, AA
    Wilkinson, KA
    Klenerman, P
    McShane, H
    Davidson, RN
    Pasvol, G
    Hill, AVS
    Lalvani, A
    [J]. JOURNAL OF IMMUNOLOGY, 2001, 167 (09) : 5217 - 5225