TreatmentUpdate61; Volume 7, No. 7 - July 1995
Sean Hosein

Ordinarily, the microbe that causes TB (Mycobacterium tuberculosis) infects the lungs. In people with strong CMI (cell-mediated-immunity), the infection can be contained by T cells. In people with immune systems weakened by

+ malnutrition + chemotherapy for cancer + corticosteroids + HIV infection

TB can infect parts of the body outside of the lungs. This sort of infection is called extrapulmonary TB.

* STUDY DETAILS

Researchers reviewed medical files (dating between 1986 to 1992) from one research centre in California in search of cases of abdominal TB that were confirmed by laboratory tests and/or X-ray scans of the abdomen. They selected 43 HIV-infected subjects and compared them to 35 non-HIV-infected subjects who also had extrapulmonary TB (67 men and 11 women). All cases of TB mentioned in this article deal with extrapulmonary TB.

* RESULTS

On average, subjects with HIV and TB in the study were younger and less likely to be alcoholics than non-HIV-infected subjects. For 83% of these subjects, a diagnosis of TB was also a diagnosis of AIDS. As well, subjects with HIV had symptoms of TB infection about 6 weeks before they sought medical care. The following (statistically significant) symptoms were more common among the HIV-infected subjects than in non-HIV-infected subjects:

+ fever + night sweats + unintentional weight loss

As well, fever temperature was greater in HIV-infected subjects. HIV-infected subjects were more likely to have reduced levels of white blood cells. To test for exposure to TB, nurses would inject a small amount of protein from TB-causing bacteria, producing swelling and redness in "6 of 14" HIV-infected subjects. This reaction suggested that the level of CMI (cell-mediated- immunity) was weak in some subjects. X-ray scans revealed that HIV-infected subjects were more likely to have persistently swollen lymph nodes In the abdomen than non-HIV-infected subjects. This difference was statistically significant.

* TB IN THE ABDOMEN

In the abdomen, HIV-infected subjects were more likely to have TB in their lymph nodes and spleen than subjects without HIV-infection. This difference was statistically significant. Compared to non-HIV-infected subjects, subjects with HIV were more likely to have TB in their:

+ lymph nodes + tissues and tubes of the genitals and urinary system + blood.

* SURVIVAL

About 25% of HIV-infected and 25% of non-HIV-infected subjects died while in hospital and "[about] 40% of those subjects died while receiving Antibiotics for TB]." According to the researchers, "Only 14 [subjects] in each group [HIV-infected and non-HIV-infected] completed [antibiotic] therapy."

* CONCLUSION

The researchers stated that a diagnosis of abdominal TB in HIV-infected subjects means that it is very likely that TB-causing microbes have spread to other parts of the body (disseminated. Indeed, they added that "increased fevers, chills, night sweats, weight loss, [very high body temperature] and ETB in lymph nodes outside of the abdomen] are signs of disseminated TB."

REFERENCES:

1. Fee MA Co MM, Gabayan AK, et al. Abdominal tuberculosis in patients infected with Human Immunodeficiency Virus. Clinical Infectious Diseases 1995;20:938-944.

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