Comparative radiological features of disseminated disease due to Mycobacterium tuberculosis vs non-tuberculosis mycobacteria among AIDS patients in Brazil

BMC Infect Dis. 2008 Feb 29;8:24. doi: 10.1186/1471-2334-8-24.

Abstract

Background: Disseminated mycobacterial disease is an important cause of morbidity and mortality in patients with HIV-infection. Nonspecific clinical presentation makes the diagnosis difficult and sometimes neglected.

Methods: We conducted a retrospective cohort study to compare the presentation of disseminated Mycobacterial tuberculosis (MTB) and non-tuberculous Mycobacterial (NTM) disease in HIV-positive patients from 1996 to 2006 in Brazil.

Results: Tuberculosis (TB) was diagnosed in 65 patients (67.7%) and NTM in 31 (32.3%) patients. Patients with NTM had lower CD4 T cells counts (median 13.0 cells/mm3 versus 42.0 cells/mm3, P = 0.002). Patients with tuberculosis had significantly more positive acid-fast smears (48.0% vs 13.6%, P = 0.01). On chest X-ray, miliary infiltrate was only seen in patients with MTB (28.1% vs. 0.0%, P = 0.01). Pleural effusion was more common in patients with MTB (45.6% vs. 13.0%, P = 0.01). Abdominal adenopathy (73.1% vs. 33.3%, P = 0.003) and splenic hypoechoic nodules (38.5% vs. 0.0%, P = 0.002) were more common in patients with TB.

Conclusion: Miliary pulmonary pattern on X-ray, pleural effusion, abdominal adenopathy, and splenic hypoechoic nodules were imaging findings associated with the diagnosis of tuberculosis in HIV-infected patients. Recognition of these imaging features will help to distinguish TB from NTM in AIDS patients with fever of unknown origin due to disseminated mycobacterial disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil
  • CD4-Positive T-Lymphocytes / immunology
  • Cohort Studies
  • HIV Infections / complications*
  • Humans
  • Male
  • Mycobacterium Infections / complications
  • Mycobacterium Infections / diagnostic imaging*
  • Mycobacterium Infections / microbiology
  • Mycobacterium tuberculosis / isolation & purification*
  • Radiography
  • Retrospective Studies
  • Tuberculosis / complications
  • Tuberculosis / diagnostic imaging*
  • Tuberculosis / microbiology