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


CONCLUSIONS
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.
dos Santos
Rodrigo P
RP
Section of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. rpsrodrigo@gmail.com
Scheid
Karin L
KL
Willers
Denise Mc
DM
Goldani
Luciano Z
LZ
D000328:Adult; D001938:Brazil; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009164:Mycobacterium Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011859:Radiography; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology