Analysis of lethal outcomes in patients with newly-diagnosed tuberculosis of the respiratory organs in combination with HIV-infection

Abstract


Aim. To analyse lethal outcomes in patients with newly-diagnosed respiratory tuberculosis comorbid with HIV-infection depending on initial count of CD4+ lymphocytes.
Material and methods. Of 304 HIV patients with newly-diagnosed tuberculosis treated in Moscow Tubercusis Hospital N 7 in 2006-2010, 40 (13.2%) patients died. Tuberculosis diagnosis was made after detection of M.tuberculosis (MT) by different tests, MT DNA in different biological material, histological verification or by effectiveness of specific antituberculous therapy. Postmortem examinations were made according to the protocol.
Results. Significant differences were detected in patients with initial count of CD4+ lymphocytes less than 50 in 1 mcl. Specific CNS affection was found in patients with initial lymphocyte count CD4+ less than 100 in 1 mcl. Most of autopsy examinations registered generalized acutely progressive tuberculosis with multiple lesions of internal organs and lymph nodes (LN). Microscopy revealed obscure morphological picture of specific inflammation with prevalence of alternative-exudative tissue reactions in the absence of a productive inflammation component. Cases with submiliary dissemination which was invisible in macroscopic examination due to a bright picture of exudative tissue reaction (rare plethora of the lungs, alveolar and interstitial edema, perifocal inflammatory reaction of nonspecific reactive nature) and small size of the lesions. The comparison of clinical and autopsy diagnoses revealed that involvement of intrathoracic LN and miliary dissemination, according to autopsy, occurred much more frequently than shown by antemortem standard x-ray examination of the chest.
Conclusion. It is strongly recommended to perform computed tomography of the chest in all HIV-infected patients with long-term fever but without visible alterations on chest x-ray.

About the authors

Vera Nikolaevna Zimina

Email: vera-zim@yandex.ru

Aleksey Viktorovich Kravchenko

Email: kravtchenko@hivrussia.net

Yuliya Rashidovna Zyuzya

Farit Akhatovich Batyrov

Email: tkb7@mosgorzdrav.ru

Anna Anatol'evna Popova

Email: asya_med.ророvа@yandex.ru

Grigoriy Vladimirovich Klimov

Email: grea75@mail.ru

Yuriy Georgievich Parkhomenko

Email: morfolhum@mail.ru

Irina Anatol'evna Vasil'eva

Email: vasil39@list.ru

V N Zimina

Central Research Institute of Tuberculosis, Moscow

Central Research Institute of Tuberculosis, Moscow

A V Kravchenko

Central Research Institute of Epidemiology, Moscow

Central Research Institute of Epidemiology, Moscow

Yu R Zyuzya

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

F A Batyrov

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

A A Popova

Central Research Institute of Epidemiology, Moscow

Central Research Institute of Epidemiology, Moscow

G V Klimov

Tuberculosis hospital N 7, Moscow

Tuberculosis hospital N 7, Moscow

Yu G Parkhomenko

Research Institute of Human Morphology, Moscow

Research Institute of Human Morphology, Moscow

I A Vasilieva

Central Research Institute of Tuberculosis, Moscow

Central Research Institute of Tuberculosis, Moscow

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Copyright (c) 2011 Zimina V.N., Kravchenko A.V., Zyuzya Y.R., Batyrov F.A., Popova A.A., Klimov G.V., Parkhomenko Y.G., Vasil'eva I.A., Zimina V.N., Kravchenko A.V., Zyuzya Y.R., Batyrov F.A., Popova A.A., Klimov G.V., Parkhomenko Y.G., Vasilieva I.A.

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