Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count.

BACKGROUND: HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse. OBJECTIVE: The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB) in HIV-seropositive patients and their relationship to CD4 counts. MATERIALS AND METHODS: It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB. RESULTS: Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC) examination. All patients with AFB-positive lymph node had CD4 count below 200/cum. CONCLUSIONS: The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT) reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore, adequate knowledge of the manifestations of tuberculosis in HIV-infected patients is absolutely necessary for optimal management and to reduce mortality and morbidity.

Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study.

OBJECTIVES: To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in patients with human immunodeficiency virus (HIV) infection. METHODS: Fifty-two patients with HIV infection were examined and screened for various opportunistic infections. CD4 cell count was done and two dimensional echocardiography was performed. RESULTS: Echocardiographic findings were identified in 22 of 52 patients (42.3%). Eighteen patients (34.6%) were having reduction in fractional shortening, 10 patients (19.2%) left ventricular diastolic dysfunction, 8 patients (15.4%) global hypokinesia and 6 patients (11.5%) pericardial effusion. Nineteen out of 22 patients having CD4 cell count <100 cells/mm3 had high prevalence of echocardiographic abnormalities. Patients with opportunistic infections had more frequent echocardiographic abnormalities than those without opportunistic infections (P < .001 for TB, candidiasis and various pneumonias). CONCLUSION: Although often not diagnosed clinically, cardiac involvement in patients with HIV infection is a clinical reality with pericardial effusion, left ventricular diastolic dysfunction, reduction in fractional shortening and global hypokinesia appearing to have a high prevalence. These echocardiographic findings are associated with clinically apparent opportunistic infections and low CD4 cell count.

Nephrotic syndrome in a patient with situs inversus totalis.

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. A spectrum of renal abnormalities of patients with situs inversus has been reported. Developmental anomalies, including agenesis, dysplasia, hypoplasia, ectopia, polycystic kidney, and horseshoe kidney, have been reported. The association of situs inversus with nephrotic syndrome is very rare. We report the first known case of situs inversus totalis with nephrotic syndrome caused by primary focal segmental glomerulosclerosis, and the possible mechanism of this association.

Deep vein thrombosis complicating severe hypernatremia, rhabdomyolysis, and acute renal failure in a patient with untreated seizure disorder.

We report a 22-year-old male patient with untreated seizure disorder, presenting with increased frequency of seizures followed by encephalopathy. Laboratory evaluation showed severe hypernatremia (175 meq/l sodium), rhabdomyolysis, and acute renal failure (ARF). Excessive insensible water loss in hot and humid weather, associated with an inability to obtain adequate water replacement, led to a hyperosmolar state (plasma osmolality, 398 mOsm/kg). He was vigorously treated with hypotonic fluid supplement and, further, needed dialysis therapy (peritoneal dialysis followed by hemodialysis) for acute renal insufficiency. The patient survived without any neurological sequelae, but the clinical course was complicated by acute deep vein thrombosis. This case represents what we believe is a unique report in the literature of severe hypernatremia developing via the pathogenic mechanism outlined above and the complication of acute peripheral venous thrombosis, which has not been reported in adults. The purpose of this report is to emphasize hyperosmolarity as a newly described cause of rhabdomyolysis, ARF, and a hypercoagulable state.