Pulmonary Tuberculosis in Sputum-Negative Brazilian AIDS Patients

Abstract

Physicians reviewed charts of 96 AIDS patients who had respiratory difficulties and who had undergone fiberoptic bronchoscopy at the Federal University Hospital in Rio de Janeiro Brazil between December 1988-February 1990. They did this to identify simple readily available clinical and laboratory predictors of pulmonary tuberculosis (TB) in AIDS patients whose sputum tested negative for TB. 13 patients had a history of previous TB but none of these experienced active pulmonary disease. Physicians diagnoses TB in 18 AIDS patients (18.75%). They depended on bacilloscopy and/or culture of bronchoalveolar lavage material to diagnose BY in 17 patients and on histopathologic findings in a biopsy fragment to do so in the other patient. If fiberoptic bronchoscopy had not been available the physicians would not have been able to diagnose TB in these patients. The clinical researchers found the significant and independent predictors of TB to include peripheral blood leukocytosis left shift in neutrophil count considerable weight loss no accompanying diagnosis of another opportunistic infection and no previous diagnosis of TB. These predictors have the potential to be used as criteria to diagnose TB in AIDS patients in developing countries where sophisticated diagnostic techniques are either not available or available in only a few hospitals. They could help health practitioners determine the need to refer AIDS patients with possible TB to tertiary health centers. In conclusion prospective studies on identifying predictors of TB in AIDS patients are needed to verify these predictors.