Tuberculosis-associated severe CD4+ T-lymphocytopenia in HIV-seronegative patients from Dakar

Objectives: To determine the frequency and associated features of severe CD4+ T-lymphocytopenia (<300 cells/mm3) in HIV-seronegative patients with tuberculosis. Methods: Statistical analysis of 430 consecutively enrolled HIV-seronegative inpatients with tuberculosis in two teaching hospitals in Dakar, Senegal. Results: The mean CD4+ cell count was 602±318.3 cells/mm3. CD4+ cell counts were below 300 cells/mm3 in 62 patients (14.4%). Patients with fewer than 300 CD4+ cells/mm3 differed from those with higher counts in being less likely to have a positive smear for acid-fast bacilli; in having a higher frequency of extrapulmonary involvement (pleural effusion, adenopathy and miliary disease) and oral candidiasis; and in having smaller tuberculin reactions, lower haemoglobin levels, less cavitation and less patchy infiltration. After adjustment for gender and age, all differences remained except miliary disease. Conclusions: A substantial percentage (14.4%) of HIV-seronegative hospitalized patients for tuberculosis in a West African country presented with severe CD4+T-lymphocyte depletion and had clinical and radiographic features indicative of more advanced disease and accompanying immunodepression. These results and those already published suggest that tuberculosis should be regarded as one of the diseases associated with a subgroup of patients with ″idiopathic CD4+ T-lymphocytopenia″. (C) 2000 The British Infection Society.