Dey S K, Pal N K, Chakrabarty M S
Calcutta School of Tropical Medicine, Calcutta 700073.
J Indian Med Assoc. 2003 May;101(5):291-2, 294, 296 passim.
An outpatients department based survey conducted in Calcutta amongst 1349 established cases of tuberculosis (TB) revealed 0.67% human immunodeficiency virus (HIV) infected cases. Those affected by HIV and TB did not show any deviation from epidemiological pattern of HIV infection in India. All contracted HIV infection by heterosexual route, mostly from Bombay (47.8%) followed by West Bengal (30.4%). In follow-up study of a cohort of 36 HIV seropositives over 3 years, 10(27.7%) developed TB. Of the 23 HIV infected cases with TB, lesions were mostly pulmonary (n = 18, 78.3%) followed by pleural effusion (n = 3;13%). Low incidence of Mycobacterium avium (intracelluarae) complex and tuberculous lymphadenopathy one case each and 52.2% positivity with 14.5 mm mean induration diameter in intradermal test with one TU PPD-RT23 are deviations from previous reports. Low incidence of cough (43.5%), marked weight loss (100%) and fever (100%) were the cardinal clinical features. TB infection on pattern suggestive of reactivation of dormant pulmonary lesions lower rate (11%) of treatment failure and infection caused by organisms other than Mycobacterium tuberculosis were other findings of the study. Importance of serosurveillance to unearth more TB cases amongst HIV infected cases for early treatment and isoniazid prophylaxis is stressed upon.
在加尔各答对1349例确诊肺结核(TB)病例进行的一项门诊调查显示,感染人类免疫缺陷病毒(HIV)的病例占0.67%。HIV和TB感染者的情况与印度HIV感染的流行病学模式没有任何偏差。所有感染者均通过异性传播途径感染HIV,大多数来自孟买(47.8%),其次是西孟加拉邦(30.4%)。在对36例HIV血清阳性患者进行的为期3年的随访研究中,10例(27.7%)发生了TB。在23例合并TB的HIV感染病例中,病变大多在肺部(n = 18,78.3%),其次是胸腔积液(n = 3;13%)。鸟分枝杆菌(胞内分枝杆菌)复合体和结核性淋巴结炎的发病率较低,各1例,用1个结核菌素单位PPD-RT23进行皮内试验时,硬结平均直径为14.5mm,阳性率为52.2%,这些与之前的报道有所不同。咳嗽发生率低(43.5%)、显著体重减轻(100%)和发热(100%)是主要临床特征。该研究的其他发现包括:TB感染模式提示潜伏性肺部病变重新激活、治疗失败率较低(11%)以及由非结核分枝杆菌引起的感染。强调了血清学监测对于在HIV感染病例中发现更多TB病例以便早期治疗和进行异烟肼预防的重要性。