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/μl and bacille Calmette-Guérin 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/μl (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.
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/μl and bacille Calmette-Guérin 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/μl (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.
Authors: Lisa V Adams; Barry N Kreiswirth; Robert D Arbeit; Hanna Soini; Lillian Mtei; Mecky Matee; Muhammad Bakari; Timothy Lahey; Wendy Wieland-Alter; Elena Shashkina; Natalia Kurepina; Jeffrey R Driscoll; Kisali Pallangyo; C Robert Horsburgh; C Fordham von Reyn Journal: J Clin Microbiol Date: 2012-05-30 Impact factor: 5.948
Authors: John A Crump; Habib O Ramadhani; Anne B Morrissey; Wilbrod Saganda; Mtumwa S Mwako; Lan-Yan Yang; Shein-Chung Chow; Boniface N Njau; Godfrey S Mushi; Venance P Maro; L Barth Reller; John A Bartlett Journal: Clin Infect Dis Date: 2012-04-16 Impact factor: 9.079
Authors: Sabine Bélard; Francesca Tamarozzi; Amaya L Bustinduy; Claudia Wallrauch; Martin P Grobusch; Walter Kuhn; Enrico Brunetti; Elizabeth Joekes; Tom Heller Journal: Am J Trop Med Hyg Date: 2015-09-28 Impact factor: 2.345
Authors: Edson José Monteiro Bello; Amabel Fernandes Correia; José Ricardo Pio Marins; Edgar Merchan-Hamann; Luis Isamu Barros Kanzaki Journal: Drug Target Insights Date: 2011-11-24