HIV and tuberculosis: partners in crime.

BACKGROUND: Tuberculosis is the commonest infection detected in HIV-infected individuals worldwide. AIM: The aim of this study is to describe the clinical, bacteriologic and radiological spectrum of tuberculosis (TB) in the setting of human immunodeficiency virus (HIV) infection in a tertiary care centre in Mumbai. METHODS: A total of 8640 HIV-infected individuals were screened for tuberculosis routinely from January 1998 to December 2003, using clinical examination, chest X-ray and abdominal ultrasonography, sputum smears for acid-fast bacilli (AFB) and culture on Lowenstein-Jensen medium. RESULTS: TB was detected in 8078 (93.5%) patients of whom 3393 (42%) had pulmonary, 3514 (43.5%) had extrapulmonary TB and 1171 (14.5%) had disseminated disease. One thousand two hundred thirty eight patients (36.5%) showed AFB in sputum, while 1154 (34%) showed growth on culture medium and 4174 had radiographic involvement. In 781 (67%) individuals disseminated disease coexisted with pulmonary involvement. All 8078 coinfected patients were treated with anti-TB therapy (ATT), of whom 6422 patients (79.5%) showed one or more adverse events. Gastritis was the commonest complaint followed by hepatitis and skin rashes. ATT resistance was detected in 482 individuals. CONCLUSION: Tuberculosis is the commonest opportunistic infection (OI) in HIV positive patients in India, showing a higher prevalence of extrapulmonary and disseminated TB and adverse events due to ATT. Early recognition of concurrent OIs and their adequate treatment and prophylaxis is essential.

Penicillium marneffei infection: an AIDS-defining illness.

A 29-year-old HIV seropositive male patient from Manipur presented with fever, cough, weight loss and asymptomatic papules and nodules all over the body. Differential diagnoses of secondary syphilis, histoplasmosis, cryptococcosis and penicilliosis were considered. Histopathological and mycological study of the skin biopsy tissue, and blood culture confirmed the diagnosis of penicilliosis. Although penicilliosis, an AIDS-defining illness, is restricted to Southeast Asia, more and more cases are being recognized in non-endemic countries.

Tuberculous abscess of rectus abdominis muscle.

Tuberculosis of skeletal muscle is very rare. A case of tuberculous abscess in rectus abdominis muscle is described in a seven year old male child. The patient presented with an abscess in the anterior abdominal wall, which subsequently ruptured. The diagnosis was made by histological examination of the excised tissue following local debridement.

Isolated tuberculous epididymo-orchitis.

Isolated epididymo-orchitis is an unusual presentation of tuberculosis. We report a case of bilateral epididymitis with right sided orchitis and scrotal involvement due to tuberculosis in a young male patient who had infertility. The diagnosis was suspected on ultrasonography of scrotum and confirmed by histological examination of scrotal and testicular tissue biopsy.