Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

ABSTRACT

Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76 percent were male. The median CD4 was 106 cells/mm³ and 71 percent had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45 percent of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7 percent vs. 63 percent; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37 percent vs. 64 percent; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

RESUMO

Foram revisados prontuários e radiografias de 38 pacientes infectados pelo HIV com culturas de escarro ou lavado broncoalveolar positivas para Mycobacterium tuberculosis no intuito de comparar características clínicas, radiológicas e baciloscópicas de pacientes HIV-positivos com tuberculose pulmonar de acordo com a contagem de linfócitos CD4. A idade média dos pacientes foi 32 anos e 76 por cento eram homens. Mediana de CD4 foi 106 cells/mm³ e 71 por cento tinham CD4 <200cel/mm³. Baciloscopia de escarro foi positiva em 45 por cento. Pacientes com CD4 <200 cel/mm³ apresentaram significativamente menos padrão pós-primário (p=0,02) e relataram emagrecimento mais freqüentemente (p=0,04). Embora sem significância estatística, pacientes com contagem mais baixa de CD4 apresentaram menor positividade na baciloscopia de escarro (p=0,18). Pacientes HIV-positivos com tuberculose pulmonar confirmada por cultura apresentam alta proporção de padrão diferentes do pós-primário na radiografia torácica. Pacientes com CD4 abaixo de 200 cells/mm³ apresentaram menos freqüentemente padrão pós-primário e maior proporção relatou perda de peso.