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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Disseminated tuberculosis in human immunodeficiency virus infection: Ineffective immunity, polyclonal disease and high mortality
International Journal of Tuberculosis and Lung Disease, Volume 15, No. 8, Year 2011
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Description
BACKGROUND: Disseminated tuberculosis (TB) is a major cause of death in patients with the acquired immunedeficiency 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. © 2011 The Union.
Authors & Co-Authors
von Reyn, Charles Fordham
United States, Lebanon
Dartmouth-hitchcock Medical Center
Kimambo, Sajida
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mtei, Lillian N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Arbeit, Robert D.
United States, Boston
Tufts University School of Medicine
Maro, Isaac I.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Bakari, Muhammad
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Matee, Mecky Isaac N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Lahey, Timothy P.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Adams, Lisa V.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Black, W.
United States, Lebanon
Dartmouth-hitchcock Medical Center
MacKenzie, Todd A.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Lyimo, Johnson J.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Tvaroha, Susan
United States, Lebanon
Dartmouth-hitchcock Medical Center
Waddell, R.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Kreiswirth, Barry N.
United States, Newark
Public Health Research Institute
Horsburgh, Charles Robert
United States, Boston
School of Public Health
Pallangyo, Kisali J.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Statistics
Citations: 54
Authors: 17
Affiliations: 5
Identifiers
Doi:
10.5588/ijtld.10.0517
ISSN:
10273719
Research Areas
Infectious Diseases
Study Design
Cohort Study