Difficulty in diagnosing tuberculosis in patients infected by the human immunodeficiency virus (HIV) and variables that determine the initiation of an empirical anti-tuberculosis treatment
Abstract
Background: coexistence of HIV and tuberculosis (TB) difficults TB diagnosis and delays indication of specific treatments. In order to identify variables that complicate TB diagnosis we conducted a review of empirical antituberculosis treatments iniciated five years ago in the Infectious Diseases Department (Cátedra de Enfermedades Infecciosas).
Methods: a descriptive retrospective study.
Definitions: confirmed TB: Mycobacterium tuberculosis culture. Highly probable TB: granuloma or caseum in cytology/histopathology or bacilli positive. Probable TB: fever remission 15 days before start of treatment and patient alive at discharge. Not confirmed TB or no TB: not reach any of the above criteria or explicit other diagnosis. Group A: confirmed TB and highly probable TB; group B: probable TB.
Results: ninety-two patients were included in the study. Group A: 82% (n = 75), they were considered as truly TB. A significative difference was recorded at the CD4 level between group A and B, 234 + 120 cells/ml and 94 + 72 cells/ml respectively (p = 0.0007).
A group of variables determine the start of the empirical treatment in most of the patients: associated prolonged fever, respiratory clinic and compatible imaging were the most frequent.
Conclusions: severe immunodepression difficults definitive diagnosis of TB. The identification of variables allows the start of empirical antituberculosis treatment in patients with HIV with a high score of posterior success.
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