Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease
Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease
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DOI：
10.1046/j.1365-3156.1998.00167.x
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发表时间：
1998-01-01
影响因子：
3.3
通讯作者：
Mason, PR
中科院分区：
文献类型：
--
作者：
Heyderman, RS;Makunike, R;Mason, PR
目的阐明HIV、CD 4（+）计数与胸膜结核病之间的关系。方法在一项前瞻性研究中，94例在哈拉雷两家大型医院就诊的临床疑似胸膜结核病患者在10个月内入选。所有患者均接受标准化评估、闭式胸膜抽吸和活检。接受直接观察抗TB治疗的患者进行了随访。结果胸膜结核被诊断为90人（中位年龄33岁;范围18-65; 64名男性）; HIV的血清阳性率为85%。HIV阳性患者比HIV阴性患者年龄大（中位年龄33岁对23岁，P = 0.013），且中位CD 4（+）计数显著较低（分别为191对1106 x 10（6）/1，P = 0.004）。CD 4（+）计数> 30天（65% vs 37%; P = 0.05），胸膜液涂片阳性（37% vs 0%; P = 0.0006）和胸膜活检Ziehl-Neelsen染色阳性（35% vs 7%; P = 0.021）。然而，CD 4（+）计数和胸膜肉芽肿形成或放射学证据的传播diseases.CONCLUSION之间的关系，在撒哈拉以南非洲，结核性胸腔积液已成为与老年人，慢性发病，并增加分枝杆菌负荷。这些数据强调了胸膜结核、HIV感染和低CD 4（+）计数之间的复杂关系。
OBJECTIVE To elucidate the relationship between HIV, CD4(+) count and pleural TB.METHOD In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10-month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti-TB therapy were followed-up.RESULTS Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18-65; 64 males); the seroprevalence of HIV was 85%. HIV-positive patients were older than HIV-negative individuals (median age 33 vs 23 years, P = 0.013) and had a significantly lower median CD4(+) count (191 vs 1106 x 10(6)/1 respectively, P = 0.004). A CD4(+) count of 30 days (65% vs 37%; P = 0.05), a positive pleural fluid smear (37% vs 0%; P = 0.0006) and a positive pleural biopsy Ziehl-Neelsen stain (35% vs 7%; P = 0.021). However, a relationship between CD4(+) count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed.CONCLUSION In sub-Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4(+) count.