Alterações radiográficas em pacientes com a co-infecção vírus da imunodeficiência humana/tuberculose: relação com a contagem de células TCD4+

Chest radiographic findings in patients with HIV/AIDS and pulmonary tuberculosis

The study describes the main chest radiographic changes in people living with HIV/AIDS and pulmonary tuberculosis, confirmed by sputum culture. This was a descriptive study involving a total of 42 sputum tests from 42 people living with HIV/AIDS and a clinical suspicion of pulmonary tuberculosis. All patients attended two referral hospitals in Recife-PE, Brazil, between August 2009 and January 2012. The most common isolated radiological change was parenchymal consolidation, encountered in six (14.3%) patients, followed by patterns of interstitial infiltrate, diffuse micronodular (miliary), and an association between interstitial infiltrate and parenchymal consolidation, each being encountered in five (11.9%) patients. No statistically significant difference was observed between the radiological findings and CD4 T-cell counts, p = 0.680.

Pretreatment and posttreatment radiography in patients with pulmonary tuberculosis with and without human immunodeficiency virus infection

PURPOSE

The purpose of this study was to determine differences in pretreatment and posttreatment radiographic findings in pulmonary tuberculosis (PTB) patients with and without human immunodeficiency virus (HIV) infection.

MATERIALS AND METHODS

All patients were reviewed in terms of pre- and posttreatment radiographic findings comparing non-HIV-related versus HIV-related PTB.

RESULTS

Among 177 PTB patients, 38 (22%) were HIV seropositive and 139 (78%) were HIV-seronegative. The most common radiographic finding in non-HIV-related TB was reticular infiltration (66.2%), whereas the miliary pattern was the most common radiographic finding in HIV-related TB (34.2%). Radiographic findings in HIV related TB significantly presented with higher prevalence of the miliary pattern (P < 0.0001) and lower prevalence of reticular infiltration (P < 0.0001), cavitation (P = 0.003), and mass-like lesions (P = 0.039) compared to non-HIV-related TB. During the posttreatment period, normal chest radiographs were significantly present in the patients who had HIV-seropositivity, the miliary pattern, and sputum negative for acid-fast bacilli during the pretreatment period (P < 0.05).

CONCLUSION

Pretreatment radiographic features of HIV-related TB had a significantly higher prevalence of the miliary pattern and lower prevalence of reticular infiltration, cavitation, and mass-like lesions. HIV-related TB and the miliary pattern seen by pretreatment radiography were significantly associated with normal chest radiographs during the posttreatment period.

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

OBJETIVO: Descrever as diferenças na apresentação clínico-radiológica da tuberculose segundo a presença ou não de infecção por HIV. MÉTODOS: Examinou-se uma amostra consecutiva de 231 adultos com tuberculose pulmonar bacilífera internados em hospital de tisiologia. A presença de infecção por HIV, AIDS e fatores associados foi avaliada e as radiografias de tórax foram reinterpretadas. RESULTADOS: Havia 113 pacientes HIV-positivos (49%). Estes pacientes apresentavam maior freqüência de tuberculose pulmonar atípica (lesões pulmonares associadas a linfonodomegalias intratorácicas), tuberculose de disseminação hemática e tuberculose pulmonar associada a linfonodomegalias superficiais e menor freqüência de lesões pulmonares escavadas do que os pacientes HIV-negativos. Isto também ocorreu entre os pacientes HIV-positivos com AIDS e os HIV-positivos sem AIDS. Não se observaram diferenças entre os pacientes HIV-positivos sem AIDS e os HIV-negativos. Os valores medianos de CD4 foram menores nos pacientes HIV-positivos com linfonodomegalias intratorácicas e lesões pulmonares em comparação aos com lesões pulmonares exclusivas (47 vs. 266 células/mm³; p < 0,0001), nos pacientes HIV-positivos com AIDS em comparação aos HIV-positivos sem AIDS (136 vs. 398 células/mm³; p < 0,0001) e nos pacientes com tuberculose pulmonar atípica em comparação aos com outros tipos de tuberculose (31 vs. 258 células/mm³; p < 0,01). CONCLUSÃO: Há um predomínio de formas atípicas e doença disseminada entre pacientes com imunossupressão avançada. Em locais com alta prevalência de tuberculose, a presença de tuberculose pulmonar atípica ou de tuberculose pulmonar associada a linfonodomegalias superficiais é definidora de AIDS.