CLINICAL SPECTRUM OF PULMONARY AND EXTRAPULMONARY TUBERCULOSIS IN HIV SEROPOSITIVE PERSONS WITH REFERENCE TO CD4 COUNT

Dr.VASIREDDY ARUNA; Dr.SABINKAR BABU LAL; Dr.KUMAR VARMA; Dr.ASHISH DEVALKAR.T

Volume : VIII, Issue : II, February - 2018

CLINICAL SPECTRUM OF PULMONARY AND EXTRAPULMONARY TUBERCULOSIS IN HIV SEROPOSITIVE PERSONS WITH REFERENCE TO CD4 COUNT

Dr. Vasireddy Aruna, Dr. Sabinkar Babu Lal, Dr. Kumar Varma, Dr. Ashish Devalkar. T

Abstract :

BACKGROUND: HIV infection is a major threat in the world population and in the

control of tuberculosis in developing countries. Infection with HIV is the most potent risk factor for progression to active tuberculosis. Clinical presentation of TB among the HIV infected is dependent on the degree of immune suppression. Patients who are severely immune suppressed are more likely to have atypical clinical and radiographic features, extra pulmonary disease and disseminated disease. Thorough work up may be required to establish the diagnosis.

OBJECTIVES: To study the various manifestations of pulmonary and extra pulmonary tuberculosis in HIV Positive patients and impact of CD4 count on the severity of manifestations of TB.

METHODOLOGY: Observational cross sectional study of 50 HIV positive patients attending Department of pulmonary medicine, Government general hospital, Siddhartha medical college, Vijayawada from March 2016 to Feuary 2017.

RESULTS: 50 HIV patients studied for period of one year. Majority of patients were in the age group of 30– 40 years. 66% were males and 34% females. Low socio economic group were commonly affected. Pulmonary TB (72%) is the most common form. Pleural effusion (30%) is common extra Pulmonary manifestation.Infiltrative lesions (66%) were more common X –ray findings with bilateral infiltrations seen in 28%of cases. Sputum positivity seen in 30% of cases. Mean CD4 count in this study is 162.54±154.37 cells/ µl. Most patients (74%) had CD4 count < 200 cells/ µl. 90.5% of sputum negative TB, 85.6% of extra pulmonary TB had CD4 <200 cells/µl. Majority of patients with upper zone lesions in chest x– ray had CD4 >200 cells/µl.

CONCLUSION : CD4 counts correlated well with clinical profile of TB, which showed that when CD4 counts were < 200 cells/ µl, sputum negative pulmonary TB and extra pulmonary TB were more,Chest x –ray were atypical in the form of lower zone involvement and more of infiltrative lesion.So,a high level of clinical suspicion is required in diagnosis of TB in HIV Infected,especially when they are in the later stage of disease which is indicated by CD4 counts < 200 cells/ µl.