Clinico-diagnostic pattern of pulmonary tuberculosis among HIV Patients

Balaji, S (2011) Clinico-diagnostic pattern of pulmonary tuberculosis among HIV Patients. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Tuberculosis is a major public health problem in many of the developing countries. This is further complicated by the HIV infection, which is a pandemic disease and also leads to the emergence of the multidrug resistant tuberculosis strains. WHO has declared tuberculosis as a global emergency in 1993 and the member nations adopt various control programmes to control the disease. HIV infection cause progressive immunodeficiency state, rendering the infected persons to increased susceptibility to various opportunistic infections, as the immune system becomes less able to prevent the growth and spread of the disease. Of these various opportunistic infections Tuberculosis is the most common disease. Mycobacterium tuberculosis infects one third of the world’s population. Worldwide there are about 8 million new cases and 3 million deaths every year. Of the majority of the cases and deaths occur in developing countries. India has the largest number of tuberculosis (TB) cases in the world. India has 14 million cases of TB and it is estimated that about 1.8 million incident cases of TB occur in India every year. Individuals infected with M. tuberculosis have an approximately 10% life time risk of developing active TB, whereas the persons infected with HIV have 10% annual risk of getting infected with tuberculosis. Conversely Mycobacterium tuberculosis accelerates the progression of the HIV infection. Hence it is essential to treat tuberculosis effectively in persons with HIV infection and reducing the mortality of these persons. OBJECTIVES OF THE STUDY : 1. To evaluate the clinical, bacteriological and radiological pattern of tuberculosis infection among HIV seropositive individuals in correlation with the CD 4+ counts. 2. To find out the pattern of Tuberculosis infection, in HIV seropositive patients attending Coimbatore medical college hospital. 3. To find the prevalence of Pulmonary Tuberculosis among HIV Seropositive patients attending Coimbatore Medical College Hospital. 4. To find the correlation between the manifestations of pulmonary tuberculosis and the CD4 count at the time of diagnosis of pulmonary tuberculosis. MATERIALS AND METHODS : This study was conducted from March 2010 to October 2010, at Coimbatore Medical College Hospital, Coimbatore. Two sets of patients were selected for the study. 1. Patients attending the OP departments of Medicine and Thoracic Medicine or patients who were admitted at the Medical wards with symptoms suggestive of Pulmonary tuberculosis, (cough of more than three weeks duration, fever, hemoptysis, loss of weight etc) were screened for Pulmonary Tuberculosis with Chest X Ray investigation and Two samples of Sputum AFB. If these patients were found positive for pulmonary tuberculosis, they were screened for HIV disease at the ICTC centre. If found positive, they were included in the study with the consent of the patient. Screening for HIV disease was done by the ELISA Rapid diagnostic tests a. Combiaids, b. Instachek, c. Acon Biotech. If one test was positive, the remaining other two tests were performed and if found positive, the diagnosis of HIV was made as per the guidelines. 2. HIV positive patients who were either under observation or under HAART, who developed symptoms and signs suggestive of Pulmonary Tuberculosis were screened for the same; if found positive for Pulmonary tuberculosis , they were included in the study after obtaining their consent. These patients were investigated as following: a. Chest X - Ray PA view, if needed Lateral view (if not done earlier). b. Sputum for AFB two early morning samples (if not done earlier). c. Blood hemoglobin, total count differential count, Erythrocyte sedimentation rate, sugar, urea d. Serum creatinine, Liver function test. e. CD4 count The chest X -ray was taken by digital imaging, read by a general physician, chest physician and a radiologist to diagnose pulmonary tuberculosis. The blood investigations were done by conventional methods. Sputum AFB was done by ZIEHL NEELSON method. CD4 count was done by the PARTEC CYFLOW COUNTER (flow cytometer). Inclusion Criteria: Patients with symptoms of pulmonary tuberculosis, who were confirmed with the diagnosis of Pulmonary tuberculosis - both Sputum AFB positive and Sputum AFB negative (diagnosed radiologically). Patients with Tuberculous Pleural Effusion were included in the study. Exclusion Criteria: 1. Patients who were suffering from Extra-pulmonary Tuberculosis infections like TB Pericarditis, TB meningitis, TB Abdomen, isolated TB lymphadenopathy, Potts Spine and other seriously ill patients. 2. Patients found to have positivity in only one of the three ELISA tests for HIV. 3. No consensus among all the three independent observers regarding the X-Ray features of Pulmonary Tuberculosis. 4. Patients suspected or confirmed Latent Tuberculosis Infection(LTBI). CONCLUSION : Pulmonary Tuberculosis is one of the commonest opportunistic infection among the HIV positive individuals. • The prevalence of Pulmonary tuberculosis is more in male than in female population of HIV positive individuals. • Pulmonary Tuberculosis occurs early in the HIV infection even before the CD 4+ count falls to very low levels. • Manual labourers, agricultural labourers, etc of lower socioeconomic state with low literacy rate were more commonly affected by HIVPTB co - infection. • Fever, cough and loss of appetite and loss of weight were most common symptoms observed in HIV with Pulmonary TB co-infection/individually. • Sputum AFB was negative in tuberculosis presentations like hilar adenopathy, military mottling, pleural effusion etc. • The radiological findings of infiltration were most common presentation, cavitatory lesions, consolidation, and pleural effusion etc follows. in that order. Lower the CD4 count, more were the incidence of pulmonary infiltration, pleural effusion, hilar adenopathy and military mottling. The cavitatory lesions manifest at higher CD4 counts. • Sputum AFB negativity was more commonly seen in pulmonary tuberculosis of seropositive HIV individuals. • Immune reconstitution inflammatory syndrome is seen in patients HAART wherein the latent TB or reinfection are seen. • Treatment of TB can prolong the life and improve the quality of life for HIV-positive people. • Knowledge of the clinico-radiological spectrum of tuberculosis and co-existing opportunistic infections is absolutely necessary for the early detection of the disease and initiating the treatment. • As the rate of rise of PTB is increasing in the HIV endemic regions, improved diagnostic testing, especially directed towards early diagnosis of PTB and for the diagnosis of latent Tuberculous infection is the need of the day. • The possibility of the occurrence of MDR TB has to be considered in cases in whom drug compliance is poor. These patients must be motivated with positive approach for regular treatment and must be monitored closely. • Facilities for ATT drug susceptibility testing must be done at the time of diagnosis of PTB so that the ATT regimen can be modified accordingly.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinico-diagnostic pattern ; pulmonary tuberculosis ; HIV Patients.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 17 Feb 2018 20:43
Last Modified: 17 Feb 2018 20:43

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