Abstract
Objective: We describe the abdominal sonographic findings among patients with HIV-tuberculosis (TB) co-infection with advanced immune suppression before initiation of ART and relate these findings to the patients’ abdominal symptoms and CD4 T-cell count. Methods: Consecutive HIV-TB co-infected patients, qualifying for ART, were prospectively enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Programme clinic in Kampala, Uganda. An abdominal ultrasound was performed at enrolment. Results: A total of 209 HIV-TB co-infected patients (76% with pulmonary, 19% with extrapulmonary TB and 5% with extrapulmonary and pulmonary TB) underwent an abdominal ultrasound scan. Only 49 patients (23.4%) had a normal abdominal ultrasound. The following sonographic abnormalities were found: multiple lymphadenopathy (38%), splenomegaly (18%), renal abnormalities (14%), gastro-intestinal tract abnormalities (thickened bowel loops, appendicitis) (13%), splenic abscesses (13%) and ascites (6%). The commonest groups of enlarged lymph nodes were in the porta-hepatis (19%) and peripancreatic (17%) area and 80% of the enlarged lymph nodes were hypoechoic. Conclusion: Most patients with advanced immune suppression and HIV-TB co-infection have sonographic evidence of generalized TB with abdominal involvement, therefore Ultrasound may assist in the early diagnosis of disseminated TB.
Highlights
The prevalence of HIV in patients with tuberculosis (TB) in sub-Saharan African countries ranges from 20% to 67%
We describe the baseline abdominal sonographic findings in patients with TB-HIV co-infection before initiation of anti-retroviral therapy (ART)
From December 17th 2007 to 31st December 2009, consecutive HIV-TB co-infected patients, qualifying for ART according to National ART treatment guidelines, were prospectively enrolled in a cohort to study the incidence of the immune reconstitution inflammatory syndrome at the National Tuberculosis and Leprosy Programme clinic [8]
Summary
The prevalence of HIV in patients with tuberculosis (TB) in sub-Saharan African countries ranges from 20% to 67%. The most common cause of death in persons with HIV infection in the tropics is TB, which is disseminated in up to 70% of patients with CD4 counts of less than 100 cells/mm3 [1] [2]. The diagnosis of TB depends on the demonstration of acid-fast bacilli in the sputum. This diagnostic process is considerably less sensitive in cases of HIV co-infection due to the fact that TB is often extra-pulmonary and when TB infects the lungs it is much more likely to be smear-negative. Ultrasound examination of the abdomen has been used in a number of centers to assist in diagnosing disseminated TB in patients with advanced HIV disease. A number of ultrasonographic findings such as lymphadenopathies with a central hypo-echoic region and splenic micro-abscesses have been regarded useful in the diagnosis of TB [6] [7]
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