To describe the presentations of patients with disseminated tuberculosis (TB) and its occurrence in patients with the comorbidity of human immunodeficiency virus (HIV) infection at Harlem Hospital from 1999 to 2002.
Retrospective chart and radiographic review. Criteria for diagnosis of disseminated TB were: miliary pattern on chest-xray/ CT or evidence of miliary TB on biopsy/ postmortem.
A total of 98 cases of TB were identified. Thirty-six(36.7%) had HIV infection, 46(46.9%) were HIV-uninfected and 16(16.3%) unknown . Eight cases (8.1%) were identified with disseminated TB (5 women, 3 male; age range 22-58 years; one foreigner. Seven cases (87.5%) were HIV-infected (CD4+ cell count: 34-212 cells/mm3) . Three (37%) were tuberculin skin test (TST) positive. Fever, night-sweats, anorexia/weight loss were seen in all with cough and dyspnea in 5(62.5%).Two patients had Central nervous involvement (multiple enhancing lesions). Two patients had normal chest-xrays. Five patients had miliary pattern on chest high resolution CT (HRCT) (one with normal chest-xray). Two patients had tree and bud pattern on HRCT, suggesting endo-bronchial spread of infection. Sputum smears were positive for acid-fast organisms in 3 patients (37.5%) and cultures were positive in 5 (62.5%). Bronchoscopy was performed on 4 patients: one caseating granuloma, one non-caseating granuloma; 2 non-diagnostic. Six patients (75%) had bacteriological confirmation (1 patient with brain biopsy). Of the 2 cultures negative cases: 1 was diagnosed at autopsy (cultures not done) and another was diagnosed on clinical grounds and response to treatment . Appropriate anti-TB treatment was initiated in 7/8 patients. Three completed 6 months treatment without relapses after 1 year. Four died and one continues on treatment with second-line anti-TB drugs due to side effects to first-line medications.
Disseminated TB is a common presentation in individuals with HIV-related TB. The severity of the disease required a high clinical suspicion, aggressive workup and prompt treatment to avoid unfavorable outcomes.
Importance of suspicion, diagnosis and prompt treatment of Disseminated TB especially in the immunocompromised individuals
V.E. Coelho-D’Costa, None.