Johnson J L, Vjecha M J, Okwera A, Hatanga E, Byekwaso F, Wolski K, Aisu T, Whalen C C, Huebner R, Mugerwa R D, Ellner J J
Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106-4984, USA.
Int J Tuberc Lung Dis. 1998 May;2(5):397-404.
TB Treatment Centre, Kampala, Uganda.
To evaluate the impact of human immunodeficiency virus (HIV) co-infection on the bacteriologic and radiographic presentation of pulmonary tuberculosis (TB) in Uganda, a nation with high rates of Mycobacterium tuberculosis and HIV infection.
To compare baseline characteristics among HIV-infected and non-HIV-infected adults with initial newly-diagnosed episodes of culture-confirmed pulmonary TB screened for participation in a randomized prospective TB treatment trial.
Negative and paucibacillary (very scanty or scanty) sputum acid fast bacilli (AFB) smears were more frequent in HIV-infected patients presenting with pulmonary TB (P = 0.007). More HIV-infected individuals also had sputum cultures that required 7-8 weeks incubation until positivity than non-HIV-infected patients (P < 0.01). Lower lung field and diffuse pulmonary infiltrates were more frequent among HIV-infected patients. Rates of atypical X-ray presentations and cavitary disease were comparable between HIV-seropositive and -seronegative patients; however, atypical disease was more frequent in HIV-infected patients with small tuberculin reactions or tuberculin anergy (PPD = 0 mm).
HIV co-infection was associated with a higher frequency of negative and paucibacillary sputum AFB smears. The differences in the diagnostic yields of microscopy and culture between HIV-infected and non-HIV-infected individuals were small and do not, in our opinion, significantly affect the utility of these important diagnostic tests in developing countries. Examining more than one sputum specimen and monitoring cultured specimens for a full 8 weeks may assist in optimizing the diagnostic yield. Upper lobe infiltrates and cavitary disease are still the most frequent radiographic presentations of pulmonary TB in HIV-infected and non-HIV-infected adults in countries with a high prevalence of TB.
乌干达坎帕拉结核病治疗中心。
在结核分枝杆菌和艾滋病毒感染率较高的乌干达，评估人类免疫缺陷病毒（HIV）合并感染对肺结核（TB）细菌学和影像学表现的影响。
比较参与一项随机前瞻性结核病治疗试验筛查的、初次新诊断为培养确诊肺结核的HIV感染和未感染成年人的基线特征。
肺结核HIV感染患者中，痰涂片抗酸杆菌（AFB）阴性和菌量少（极少或少量）更为常见（P = 0.007）。与未感染HIV的患者相比，更多HIV感染个体的痰培养需要7 - 8周的孵育才呈阳性（P < 0.01）。HIV感染患者下肺野和弥漫性肺浸润更为常见。HIV血清阳性和血清阴性患者的非典型X线表现和空洞性疾病发生率相当；然而，在结核菌素反应小或结核菌素无反应（PPD = 0 mm）的HIV感染患者中，非典型疾病更为常见。
HIV合并感染与痰涂片AFB阴性和菌量少的频率较高有关。HIV感染和未感染个体在显微镜检查和培养诊断率上的差异较小，我们认为，这不会显著影响这些重要诊断测试在发展中国家的效用。检查多个痰标本并对培养标本进行整整8周的监测可能有助于优化诊断率。在结核病高发国家，上叶浸润和空洞性疾病仍然是HIV感染和未感染成年人肺结核最常见的影像学表现。
