Comparative Study of Radiological Features of Pulmonary Tuberculosis in HIV Infected Patients in Correlation with CD4 Counts

Title: Comparative Study of Radiological Features of Pulmonary Tuberculosis in HIV Infected Patients in Correlation with CD4 Counts

Authors: Dr T.V.S.R.Raghu MD, Dr S. Sarath Kumar

DOI: https://dx.doi.org/10.18535/jmscr/v4i12.59

Abstract

Tuberculosis, an ancient disease, and a major public health problem which is now complicated by relentless spread of HIV & AIDS pandemic and the emergence of multi drug resistant strains.HIV and TB, each disease speeds up the progress of the other. The study was conducted to compare various radiographic presentation of pulmonary tuberculosis in HIV positive patients with CD4 count more than 200 / μL and CD4 count < 200 / μL. 100 HIV positive patients with pulmonary tuberculosis of 20 – 70 years of age (mean age 39.53 ± 10.82) were selected for the study. Their mode of X-ray presentation and CD4 cell counts were studied. X-rays were reported by Radiologist and statistical comparison were analysed using Z test and χ2 test. CD4 count of 35 cases were more than 200 / μL and 65 cases were less than 200 / μL. It was observed that patients with CD4 count > 200 /μL shows higher incidence of upper zone distribution of alveolar, higher incidence of cavity and higher incidence of fibrosis as compared to patients with CD4 count < 200 /μL. Multiple cavities are more often found in patients with CD4 count >200/ μL. Patients with CD4 count < 200 / μL shows higher incidence of mid and lower zone infiltrate, higher incidence of pleural effusion, higher incidence of adenopathy and higher incidence of miliary mottling as compared to patients with CD4 count > 200 / μL.

Keywords: Tuberculosis, HIV, CD4, Cavity, Fibrosis, Infiltrates, Pleural effusion, Miliary mottling, Adenopathy.

References

1. A. Zumla, P. Mwaba, J. Huggett, N. Kap-ata, D. Chanda and J. Grange. ”Reflections on the white plague”. The Lancet infectio-us disease Vol 9, no : 3, PP 197-202, 2009.

2. Mayer, K. “Synergistic Pandemics: Confr-onting the Global HIV and Tuberculosis Epidemics” Clinical Infectious Diseases, 2010, Vol 50, Supplement 3, S67.

3. Suchindran,S. “Is HIV infection a Risk Factor for Multi-Drug Resistant Tuberculosis? A Systematic Review” PLoS one, May 2009, 4(5): e5561

4. WHO, Global tuberculosis report.2015.

5. WHO, Policy on collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders.2015.

6. E. Walters, M.F. Cotton, H. Rabie, H.S. Simon, L.O. Walters, and B.J. Marais, “Clinical presentation and outcome of TB in HIV infected children on ARV therapy”. BMC pediatrics, Vol 8, article no. 1, 2008.

7. WHO, TB/HIV Fact Sheet. 2015.

8. UNAIDS, Fact Sheet. 2014.

9. Ministry of Health and Family Welfare, TB INDIA 2015, RNTCP ANNUAL STATUS REPORT.

10. Ministry of Health and Family Welfare, NACO, Annual Report 2013-14.

11. Swaminathan S, Ramachandran R, Bhaskaran G. Development of TB in HIV infected individual in India. Int. J Tuberc & Lung Dis 2004; 4, 839-44.61

12. Mahesh Padyana, Raghavendra V.Bhat et al, HIV- Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count. N Am J Med Sci.2012 May; 4(5):221-225.

13. Hayman J. Mycobacterium ulcerans: An infection from Jurassic time ? Lancet 1984 ; 2 : 1015-1016.

14. Gutierrez MC, Brisse S, Brosch R, et al. Ancient origin and gene mosaicism of the progenitor of Mycobacterium tuberculosis. PloS Pathog 2005;1:e%.

15. Cave AJE. The evidence for the incidence of tuberculosis in ancient Egypt. Br J Tuberc 1939 ; 33 : 142-152.

16. Morse D, Brothwell Dr, Ucko PJ. Tuberculosis in ancient Egypt. Am Rev Respir Dis 1964 ; 90 : 5224-5241.

17. Morse D. Tuberculosis. In : Brothwell D, Sandison AT (eds.) Diseases in Antiquity. A Survey of the Diseases, Injuries and Surgery of Early populations. Springfield. IL : CC Thomas, 1967.

18. Crubezy E, Lude B, Poveda J-D, et al. Identification of Mycobacterium DNA in an Egyptian Pott’s disease of 5400 years old. C R Acad Sci III 1998 ; 321 : 941-951.

19. Koch R, Die Aetiologic der Tuberculose (a translation by Berna Pinner and Max Pinner with an introduction by Allen K. Krause). Am Rev tuberc 1932 ; 25 : 285-323.

20. Ryan F. The Forgotten Plague : How the Battle against Tuberculosis Was Won – and Lost. Boston, MA : Little, Brown, 1992.

21. Daniel TM. The origins and precolonial epidemiology of tuberculosis in the Americas : can we figure them out ? Int J Tuberc Lung Dis 2000 ; 4 : 395-400.

22. Daley CL, Small PM, Schecter GF, et al. An outbreak of TB with accelerated progression among persons infected with HIV. An analysis using restriction – fragment length polymorphism. N Engl J Med 1992 ; 326 : 231-235.

23. Di Perri G, Cruciani M. Danzi MC et al. Nosocomial epidemic of active TB among HIV infected patients. Lancet 1989 ; 2 : 1502-1504.

24. Gedde – Dahl T – Tuberculous infection in the light of tuberculin matriculation. Am J Hyg 1952 ; 56 : 139-214.

25. Selwyn PA, Hartel D, Lewis VA, et al. A prospective study of the risk of TB among intravenous drug users with HIV infection. N Engl J Med 1989; 320 : 545-550.

26. Lawn SD, Butera ST, Shinnik TM, Tuberculosis unleashed. The impact of HIV infection on the host granulomatous response to M. TB Microbes infect 2002 ; 4 : 635-646.

27. Ackah AN, Coulibaly D, Digbeu H et al. Response to treatment, mortality and CD4 lymphocyte count in HIV infected persons with TB in Abidjan, Cote d’ivoire. Lancet 1995 ; 345 : 607-610.

28. Elliott AM. Halwindi B, Hayes RJ et al. The impact of HIV on presentation and diagnosis of TB in a cohort study in zambia. J Trop Med Hyg 1993 ; 96 : 1-11.

29. Lawn SD, Evans AS, Sedgwick PM et al. Pulmonary TB : Radiological features in west Africans co-infected with HIV. Br J Radiol 1999 ; 72 : 339-334.

30. Cobelens FG, Egwaga Sm, Van GT et al. Tuberculin skin testing in patients with HIV infection limited benefit of reduced cutoff values. Clin Infect Dis 2006 ; 43 : 634-639.

31. Elliott AM, Halwindi B, Hayes R J et al. The impact of HiV on presentation and diagnosis of TB in a cohort study in Zambia. J Trop Med Hyg 1993 ; 96 : 1-11

32. Lucas SB, Nelson AM. Pathogenesis of tuberculosis in HIV infected people. In : Bloom BR (ed). Tuberculosis ; pathog-enesis, protection and control, Washington DC : ASM press 1994 : 503-513.

33. Clerici M. Stocks NI, Zajac RA et al. Detection of three distinct pattern of T helper cell dysfunction in asymptomatic HIV positive patients. Independence of CD4 cell numbers and staging. J clin Invest 1989 ; 84 : 1892-1899.

34. Sonnenberg P, Glynn JR, Fielding K et al. How soon after infection with HIV does the risk of TB start to increase ? A retrospective cohort study in South African gold miners. J infect Dis 2005; 191:150-158.

35. Rosenberg ZF, Fausi AS, The immuno pathogenesis of HIV infection. Adv Immunol 1989 ; 47 : 377 – 431.

36. Kanazawa S, Okamoto T, Peterlin BM. Tat competes with CIITA for the binding to P-TEFb and blocks the expression of MHC class II genes in HIV infection. Immunity 2000 ; 12 : 61-70.

37. Spell berg B, Edwards JE, Type I / Type II immunity in infectious disease. Clin Infect Dis 2001 ; 32 : 76-102.

38. Max, Sun J, Papasavvas E et al. Inhibition of IL-12 production in human monocyte – derived macrohages by TNF J immunol 2001 ; 164 : 1722-1729.

39. Vanham G, Penne L, Devalck J et al. Decreased CD4 ligand induction in CD4 T cell and dysregulated IL – 12 production during HIV infection. Clin Exp Immunol 1999 ; 117 : 335-342.

40. Hazenberg MD, Hamann D, Schuitemaker H et al. T cell depletion in HIV-1 infeciton. How CD4 T cells go out of stock. Nat immunol 2001 ; 1 : 285-289.

41. Law KF, Jagirdar J, Weiden MD, et al. TB in HIV patients : cellular response and immune activation in the lung. Am S Respir Crit Care Med 1996 ; 153 : 1377-1384.

42. Lawn SD, Butera ST, Shinnick TM, Tuberculosis unleashed. The impact of HIV infection on the host granulomatous response to mycobacterium tuberculosis Microbes Infect 2002 ; 4 : 635-646.

43. Whalen C, Horsberg CR, Hom D et al. Accelerated course of HIV infection after tuberculosis. AM J Respir Crit Care Med 1995 ; 151 : 129-135.

44. Badri M, Ehrlich R, wood R et al. Association between TB and HIV disease progression in a high TB prevalence area. Int J Tuber Lung Dis 2001 ; 5 : 225-232.

45. Lawn St, Butera SD, Folks TM. Contribution of immune activation to the pathogenesis and transmission of HIV type 1 infection. Clin microbiol Rev 2001 ; 14 : 753-777.

Corresponding Author

Dr T.V.S.R.Raghu MD

Assistant Professor, Dept of General Medicine, Government Siddhartha Medical College, GGH, Vijayawada

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