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Title: Disseminated tuberculosis in the acquired immunodeficiency syndrome era.
Title Abreviation: Am Rev Respir Dis Date of Pub: 1991 Nov
Author: Hill AR; Premkumar S; Brustein S; Vaidya K; Powell S; Li PW; Suster B;
Issue/Part/Supplement: 5 Volume Issue: 144 Pagination: 1164-70
MESH Headings: Acquired Immunodeficiency Syndrome (*CO/DI/EH/EP/PA); Adult; AIDS-Related Complex (CO/DI/EH/EP/PA); Biopsy; Comparative Study; Female; Haiti (EH); Hispanic Americans; Human; Male; Middle Age; New York City (EH/EP); Opportunistic Infections (*CO/DI/EH/EP/PA); Risk Factors; Substance Abuse, Intravenous (CO); Tuberculosis, Miliary (*CO/DI/EH/EP/PA); -AA-;
Journal Title Code: 426 Publication Type: JOURNAL ARTICLE
Date of Entry: 911204NEntry Month: 9202
Country: UNITED STATES Index Priority: 1
Language: Eng Unique Identifier: 92060350
Unique Identifier: 92060350 ISSN: 0003-0805
Abstract: To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987. Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1). A total of 20 had TB unrelated to HIV disease (Group 2). The remaining 12 were excluded because the role of HIV could not be determined. Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03). Chest radiographs showed a miliary pattern in about half of each group. Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group. Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1. Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01). Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli. HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract By: Author
Address: Department of Medicine, State University of New York Health Science Center, Brooklyn 11203.