PURPOSE: In India, Tuberculosis [TB] is the most common opportunistic infection in people living with HIV/AIDS. About 40% of the population in India is estimated to be infected with TB bacillus. The annualincidence of smear positive TB is estimated to be 75 per 100,000 population (based on Annual Risk of Tuberculous Infection (ARTI) study. It is estimated that 50 to 60 % of HIV infected people will develop TB disease in their lifetime when compared to 10% of HIV negative persons infected with TB. Three Mycobacterial smears on two consecutive days and chest radiography can aid us in the diagnosis of tuberculosis as according to the Revised National Tuberculosis Control Program Guidelines followed in India. CD4 T Lymphocyte count enables us to understand the patients’ immune status.
METHODS: The study was done over a period of 7 months at Government Chest Diseases and Tuberculosis Hospital, Warangal. A total of 47 patients were included in the study. Three samples of sputum for acid-fast bacilli, which is comparable to one Mycobacterial culture, were done and a chest radiograph was taken. CD4 T Lymphocyte count was compared with the Mycobacterial smears and chest radiograph.
RESULTS: Out of 47 patients, 28(59.57%) had CD4+ Lymphocytes <200Cells/αL. Out of 47 patients, 7(14.89%) were positive for Mycobacterial smears out of which 4(57.14%) of them had CD4 T Lymphocyte count less than 200 cells/αL. In patient with CD+ Lymphocytes <200α/L, 6(12.76%) had normal chest radiography, 9(19.14%) had consolidation, 9(19.14%) had pleural effusions, 1(2.12%) had miliary pattern, 1(2.12%) had hilar lymphadenopathy, 1(2.12%) had hydropneumothorax, 1(2.12%) had pneumothorax.
CONCLUSION: CD 4 T Lymphocyte count has no impact on the Mycobacterial smears. Consolidation and pleural effusions were most common radiographic presentations with CD4 T Lymphocyte count <200cells/αL followed by normal chest radiograph.
CLINICAL IMPLICATIONS: Mycobacterial smears should be done in HIV Seropositive patients with respiratory symptoms for the diagnosis of tuberculosis, irrespective CD4 T Lymphocyte count. Chest radiography may show atypical presentations not specific for tuberculosis when CD4 T Lymphocyte count <200cells/αL.
DISCLOSURE: Richards Kakumanu, No Financial Disclosure Information; No Product/Research Disclosure Information