Analysis of lethal outcomes in patients with newly-diagnosed tuberculosis of the respiratory organs in combination with HIV-infection
- Authors: Zimina V.N.1, Kravchenko A.V.1, Zyuzya Y.R.1, Batyrov F.A.1, Popova A.A.1, Klimov G.V.1, Parkhomenko Y.G.1, Vasil'eva I.A.1, Zimina VN2, Kravchenko AV3, Zyuzya Y.R4, Batyrov FA4, Popova AA3, Klimov GV4, Parkhomenko Y.G5, Vasilieva IA2
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Affiliations:
- Central Research Institute of Tuberculosis, Moscow
- Central Research Institute of Epidemiology, Moscow
- Tuberculosis hospital N 7, Moscow
- Research Institute of Human Morphology, Moscow
- Issue: Vol 83, No 11 (2011)
- Pages: 25-31
- Section: Editorial
- URL: https://ter-arkhiv.ru/0040-3660/article/view/30924
- ID: 30924
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Full Text
Abstract
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.
Keywords
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, MoscowCentral Research Institute of Tuberculosis, Moscow
A V Kravchenko
Central Research Institute of Epidemiology, MoscowCentral Research Institute of Epidemiology, Moscow
Yu R Zyuzya
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
F A Batyrov
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
A A Popova
Central Research Institute of Epidemiology, MoscowCentral Research Institute of Epidemiology, Moscow
G V Klimov
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
Yu G Parkhomenko
Research Institute of Human Morphology, MoscowResearch Institute of Human Morphology, Moscow
I A Vasilieva
Central Research Institute of Tuberculosis, MoscowCentral Research Institute of Tuberculosis, Moscow
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