Radiographic presentation of pulmonary tuberculosis in severely immunosuppressed HIV-seropositive patients

被引:13
作者
Asimos, AW
Ehrhardt, J
机构
[1] Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
[2] Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861
关键词
tuberculosis; acquired immunodeficiency syndrome (AIDS); HIV infection; chest radiograph; CD4; lymphocyte;
D O I
10.1016/S0735-6757(96)90049-2
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Although the presence of typical postprimary or ''reactivation'' pattern tuberculosis (TB) on chest radiograph (CXR) strongly suggests Tn infection in adults, the sensitivity of this finding, particularly in severely immunosuppressed human immunodeficiency virus (HIV) patients, is unclear. To investigate this issue, HIV status, CD4 counts, and CXR findings of all adult patients with culture proven TB admitted to a tertiary-care hospital over a 2-year period were retrospectively studied. CXRs were classified as typical for postprimary Tn if they showed upper lobe opacities with or without cavitation. No attempt was made to correlate the actual clinical phase of Tn infection (primary versus postprimary) with CXR patterns, largely because differentiating primary from postprimary TB in HIV patients is difficult due to high anergy rates and inability to skin-test-convert. Of 46 patients who had chest radiographs and medical records documenting HIV status available for review, 23 were HIV seropositive and 23 were HIV-seronegative. Of 22 HIV-seropositive patients whose CD4 counts were available, 18 (82%) had CD4 counts of <200 cells/mu l. Only 2 of these 18 (11%) had CXRs showing a typical postprimary TB pattern, whereas all 4 (100%) patients with CD4 counts of >200 cells/mu l and 18 of 23 (78%) non HIV patients had CXRs typical for postprimary TB (P<.005). It was concluded that HIV-seropositive patients with TB and CD4 counts of <200 cells/mu L frequently present with chest radiographs atypical for postprimary TB, including normal CXRs. Typical postprimary TB CXR findings are not sensitive for diagnosing pulmonary Tn in this population. Copyright (C) 1996 by W.B. Saunders Company.
引用
收藏
页码:359 / 363
页数:5
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