Radiographic appearances of pulmonary tuberculosis in HIV-1 seropositive and seronegative adult patientsKawooya; M.Okwera; A

ABSTRACT

Objective: To describe the radiographic pattern of PTB in HIV - 1 seropositive and seronegative patients and to study the relationship between radiographic pattern and degree of immunosuppression based on CD4 counts.Design:Cross_sectional;descriptive study. Subjects: One hundred and fifty consecutive adult patients; suspected on clinical grounds to have PTB. Setting: TB treatment centre and Department of Radiology; Mulago Referral Hospital and Makerere University Medical Teaching Hospital; Uganda. Interventions: Three early morning sputum specimens and 10 mls of venous blood taken from each qualifying subject. Main out come measures: Chest X-ray changes and CD4 counts. Results:More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderately immunosuppressed; 27.2were mildly immunosuppressed or had normal immune status. Approximately ninety three per cent of the seronegative individuals had normal immune status or were mildly immunosuppressed; while 6.4were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7 of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3respectively. Fibrosis and pleural effusion were observed in 25.3 and 41.3 respectively. Miliary disease occured in 2.0. Seropositives accounted for 81.5and 76.3 of patients with lymphadenopathy and pleural effusion; 18.5 and 23.7 respectively were seronegative. Seronegatives accounted for 64.9 and 64.5of those with fibrosis and cavitation respectively; whereas 35.1 and 35.5 of fibrosis and cavitation respectively were seropositive. Patients who were moderate to severely immunosuppressed accounted for 64;6and 63.2 of patients with lymphadenopathy and pleural effusion; 35.4 and 36.8 respectively had normal immune status or were mildly immunosuppressed (78.4and 72.6) than in moderately to severely immunosuppressed patients (21.6 and 27.4)(p0.001). Conclusion: HIV-seropositivity with moderate to severe immunesuppression are associated with atypical radiographic appearences in adult post primary PTB