Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease.
OBJECTIVE
To elucidate the relationship between HIV, CD4+ count and pleural TB.


METHODS
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)/l respectively, P = 0.004). A CD4+ count of <200 x 10(6)/l was associated with a length of illness >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.


CONCLUSIONS
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.
Heyderman
R S
RS
Department of Medicine, Medical School, University of Zimbabwe.
Makunike
R
R
Muza
T
T
Odwee
M
M
Kadzirange
G
G
Manyemba
J
J
Muchedzi
C
C
Ndemera
B
B
Gomo
Z A
ZA
Gwanzura
L K
LK
Mason
P R
PR
D000328:Adult; D000368:Aged; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000276:immunology / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology; D011446:Prospective Studies; D014396:Tuberculosis, Pleural / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D015030:Zimbabwe / Q000453:epidemiology