Urogenital tuberculosis in immunocompromised patients.
OBJECTIVE
Compare the clinicoradiological presentation of urogenital tuberculosis (UGT) between immunocompromised and nonimmunocompromised patients.


METHODS
Eighty patients diagnosed with UGT were divided into two groups: eight immunocompromised patients (four with acquired immunodeficiency syndrome [AIDS], and four renal transplant patients on immunosuppressive therapy) and 72 nonimmunocompromised patients. The groups were compared as for age, signs and symptoms, diagnostic approach, pattern of urogenital organ involvement, and early specific mortality (within 6 months from diagnosis).


RESULTS
AIDS patients were younger (median age 26 years, range 16-38 years), and renal transplant patients were older (median age 51.5 years, range 45-57 years), compared with the nonimmunocompromised subjects (median age 35 years, range 12-75 years). Immunocompromised patients had greater frequency of fever (87.5% versus 43.1%, P = 0.024), lower frequency of storage symptoms (37.5% versus 76.4%, P = 0.033), shorter length of disease (<6 months: 87.5% versus 2.8%, P < 0.001), and larger frequency of disseminated tuberculosis (62.5% versus 18.1%, P = 0.012). Predominantly parenchymatous renal involvement was more frequent in immunocompromised patients (87.5% versus 6.2%, P < 0.001), who also had lower frequency of stenosis of the collecting system (12.5% versus 93.8%, P < 0.001) and contracted bladder (12.5% versus 65.3%, P = 0.001).


CONCLUSIONS
UGT has a different clinicoradiological presentation in immunocompromised patients, with predominance of systemic symptoms, disseminated tuberculosis, multiple parenchymatous renal foci, and lower frequency of lesions of the collecting system. In the context of immunosuppression, UGT behaves as a severe bacterial infection, with bacteremia and visceral metastatic foci.
Figueiredo
Andre Avarese
AA
Division of Urology, Medical School, University of Sao Paulo, Sao Paulo, Brazil. andreavaresef@gmail.com
Lucon
Antonio Marmo
AM
Júnior
Renato Falci
RF
Ikejiri
Diego Shiguemi
DS
Nahas
William Carlos
WC
Srougi
Miguel
M
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014401:Tuberculosis, Urogenital / Q000175:diagnosis* / Q000276:immunology* / Q000401:mortality; D055815:Young Adult
D007166:Immunosuppressive Agents