Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality
| Autor: | Isaac Maro, Timothy Lahey, Muhammad Bakari, Lillian Mtei, Lisa V. Adams, S Kimambo, Mecky Matee, Todd A. MacKenzie, Robert D. Arbeit, Richard Waddell, C. R. Horsburgh, Barry N. Kreiswirth, Susan Tvaroha, C. F. von Reyn, W Black, Johnson J. Lyimo, Kisali Pallangyo |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Time Factors Tuberculosis Genotype Population Tuberculin Enzyme-Linked Immunosorbent Assay HIV Infections Kaplan-Meier Estimate Lymphocyte Activation Tanzania Mycobacterium tuberculosis Interferon-gamma Tuberculosis diagnosis Acquired immunodeficiency syndrome (AIDS) Humans Medicine Lymphocytes Prospective Studies education Cell Proliferation Immunity Cellular education.field_of_study Chi-Square Distribution biology Tuberculin Test business.industry Sputum Prognosis medicine.disease biology.organism_classification CD4 Lymphocyte Count Infectious Diseases Immunology BCG Vaccine Female Radiography Thoracic medicine.symptom business Empiric therapy |
| Zdroj: | The International Journal of Tuberculosis and Lung Disease. 15:1087-1092 |
| ISSN: | 1027-3719 |
| DOI: | 10.5588/ijtld.10.0517 |
| Popis: | BACKGROUND: Disseminated tuberculosis (TB) is a major cause of death in patients with the acquired immune-deficiency syndrome (AIDS) but its pathogenesis and clinical features have not been defined prospectively. METHODS: Human immunodeficiency virus (HIV) infected adults with a CD4 count >/= 200 cells/mul and bacille Calmette-Guerin scar underwent immunologic evaluation and subsequent follow-up. RESULTS: Among 20 subjects who developed disseminated TB baseline tuberculin skin tests were >/=15 mm in 14 (70%) and lymphocyte proliferative responses to Mycobacterium tuberculosis were positive in 14 (70%). At the time of diagnosis fever >/=2 weeks plus >/=5 kg weight loss was reported in 16 (80%) patients abnormal chest X-rays in 7/17 (41%) and positive sputum cultures in 10 (50%); median CD4 count was 30 cells/mul (range 1-122). By insertion sequence (IS) 6110 analysis 14 (70%) blood isolates were clustered and 3/8 (37%) concurrent sputum isolates represented a different strain (polyclonal disease). Empiric TB treatment was given to eight (40%) patients; 11 (55%) died within a month. CONCLUSIONS: Disseminated TB in HIV occurs with cellular immune responses indicating prior mycobacterial infection and IS6110 analysis suggests an often lethal combination of reactivation and newly acquired infection. Control will require effective prevention of both remotely and recently acquired infection and wider use of empiric therapy in patients with advanced AIDS and prolonged fever. |
| Databáze: | OpenAIRE |
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