Valencia ME, Moreno V, Soriano V, Laguna F, Ortega A, March J, Cobo G, Lahoz J; International Conference on AIDS.
Int Conf AIDS. 1996 Jul 7-12; 11: 326 (abstract no. Tu.B.2354).
Clinical Investigation Center (CIC), Madrid, Spain.
Introduction: Abdominal TB with splenic and/or hepatic abscesses (SHA) is uncommon in patients with HIV infection and diagnosis may be difficult. We describe a group of patients diagnosed of this form of disseminated TB. Patients and methods: Patients with HIV infection and TB seen during a 18 month period (1/94-6/95) were reviewed. Thirty three cases had multidrug-resistant TB (MDR-TB) and 35 had sensitive-TB. Twenty three patients with TB and SHA were selected. Diagnosis was made following the presence of hepatomegaly and/or splenomegaly with multiple filling defects in the abdominal ultrasonography (US) and isolation of Mycobacterium tuberculosis in clinical specimens. Drug-sensitivity was performed for: isoniazid (H), rifampin (R), streptomycin (S), ethambutol (E) and ethionamide (T). Results: Men/Female=19/4. Mean age: 31 years (24-48). Sixteen were IVDA, 6 homosexual and one heterosexual. From 35 isolates with sensitive-TB, 3 had SHA (8%) and from 33 with MDR-TB, 20 (60%). The pattern of resistence was: 18 to HRES, 1 to HREST and 1 to HR. Mean CD4+ was 37 plus or minus 7 (2-112) and those with MDR-TB had had the lowest. Seven patients had had previous TB (30%) and 18 (78%) had another opportunistic infection. Clinical manifestations were: fever (100%), abdominal pain (65%), constitutional syndrome (70%) and respiratory symptoms (70%). Laboratory data showed cholostasis in 87% and chest ray was abnormal in all patients: pulmonary infiltrates (78%), hiliar lymphadenopaty (74%), pericardial effusion (30%) and pleural effusion (9%). Abdominal US showed hepatoes-plenomegaly with filling defects in liver in 12 cases (52%), in spleen in 18 (78%) and retroperitoneal lymphadenopathy in 10 (43%). M. tuberculosis was isolated in sputum (96%), urine (26%), lymphadenopathy (18%) and liver biopsy (4%). Patients with MDR-TB died during 6 months following diagnosis and those with sensitive TB are alive but required glucocorticoids as adjuvant therapy because slow response to antituberculous treatment. Splenectomy was avoided. Conclusions: 1.- Abdominal TB with SHA is an increased form of extrapulmonary TB in HIV subjects. 2.- It seems to be more frequent in patients severely immunodepressed and with MDR-TB. 3.- The response to treatment with antituberculous drugs is delayed, even in those patients with sensitive TB and sometimes use of glucocorticoids can avoid splectomy.
Publication Types:
Keywords:
- Abdominal Abscess
- Acquired Immunodeficiency Syndrome
- Ethambutol
- Ethionamide
- Female
- HIV Infections
- HIV Seropositivity
- Humans
- Isoniazid
- Liver Abscess
- Male
- Mycobacterium tuberculosis
- Rifampin
- Splenic Diseases
- Tuberculosis
Other ID:
UI: 102218455
From Meeting Abstracts