Pulmonary Tuberculosis Co-infection Research Articles

The co-infection of pulmonary hydatid cyst, lophomoniasis and tuberculosis in a patient with resistant respiratory symptoms; a case report study

BackgroundLophomonas blattarum is a rare protozoan that causes opportunistic infections, and the co-infection of lophomonas with tuberculosis and human hydatidosis is a serious public problem in the co-endemic areas of developing countries.Case reportWe presented a 58-year-old female with fever, losing weight, and cough with whitish-yellow sputum that started one month ago. Increasing inflammatory markers and hypereosinophilia in laboratory tests, and a cavity with thick, regular walls and undulating air-fluid levels measuring 43 × 30, evident in the upper segment of the right lower lobe (RLL), along with consolidation and the ground glass opacity of the upper segment and posterior basal of the RLL is apparent in CT scan were reported. Then, a bronchoscopy was requested, and the BAL specimen reported a negative fungal and bacterial infection in the samples. Several live and oval flagellated lophomonas protozoa, hydatid cyst protoscoleces (the larval forms of the parasites), and M. tuberculosis were observed in microscopic evaluation. The patient was treated with metronidazole, oral albendazole, and a combination of TB regimen.ConclusionPhysicians should always consider the possibility of co-infections of lophomonas with tuberculosis and human hydatidosis and investigate patients with risk factors such as immunodeficiency conditions or treated with immunosuppressive medications.

Impact of the COVID-19 Pandemic on the Epidemiological Situation of Pulmonary Tuberculosis-Using Natural Language Processing.

We aimed to analyze the impact of the COVID-19 pandemic on pulmonary tuberculosis (TB) using artificial intelligence. To do so, we compared the real-life situation during the pandemic with the pre-2020 situation. This non-interventional, retrospective, observational study applied natural language processing to the electronic health records of the Castilla-La Mancha region of Spain. The analysis was conducted from January 2015 to December 2020. A total of 2592 patients were diagnosed with pulmonary tuberculosis; 64.6% were males, and the mean age was 53.5 years (95%CI 53.0-54.0). In 2020, pulmonary tuberculosis diagnoses dropped by 28% compared to 2019. In total, 62 (14.2%) patients were diagnosed with COVID-19 and pulmonary tuberculosis coinfection in 2020, with a mean age of 52.3 years (95%CI 48.3-56.2). The main symptoms in these patients were dyspnea (27.4%) and cough (35.5%), although their comorbidities were no greater than patients with isolated TB. The female sex was more frequently affected, representing 53.4% of this patient subgroup. During the first year of the COVID-19 pandemic, a decrease was observed in the incidence of pulmonary tuberculosis. Women presented a significantly higher risk for pulmonary tuberculosis and COVID-19 coinfection, although the symptoms were not more severe than patients diagnosed with pulmonary tuberculosis alone.

Asymptomatic Pulmonary Cryptococcosis And Tuberculosis Co-infection in an immunocompetent Host: A case report

Pulmonary Cryptococcosis is a rare fungal infection that mostly occurs in immunocompromised host. However, with advancement in diagnostic approach like tissue biopsy, cryptococcal infections are now increasingly being recognised.In immunocompetent host, cryptococcal infection is often asymptomatic and rarely becomes disseminated.
 Symptom development in immunocompetent host largely depends on burden and virulence of pathogen. Due to similarities in clinical, radiological and pathological findings in Cryptococcosis, Tuberculosis and other fungal infections like Blastomycocosis, it is important to have a tissue biospy to confirm the diagnosis.
 The aim of this case report is to highlight the investigation necessary to diagnose both fungal infection and Tuberculosis due to similar clinical, radiological features in both. We report a case of Gene Xpert positive Tuberculosis and histopathology proven Pulmonary Cryptococcos in same patient.

Clinical and Microbiological Characteristics of Klebsiella pneumoniae Co-Infections in Pulmonary Tuberculosis: A Retrospective Study.

Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens leading to pulmonary tuberculosis (PTB) co-infection, but the data of co-infections is scarce. This research aimed to study the clinical and microbiological characteristics of K. pneumoniae co-infections in pulmonary tuberculosis cases. Clinical manifestations and examination results of PTB cases co-infected by K. pneumoniae were retrospectively collected from the medical record database of a tertiary teaching hospital in China between November 2019 and October 2021. The K. pneumoniae strains isolated from the patients were sent for whole-genome sequencing. Statistical analyses were conducted using Stata v.14.0. A total of 80 strains were collected from 76 PTB patients with K. pneumoniae co-infections (two strains were isolated from each of the four patients at different time points), including 37 primary and 39 retreated TB cases. Among these, 29 (36.3%) of the K. pneumoniae isolates were extended-spectrum β-lactamase (ESBL)-producing strains, and seven (8.8%) were determined as carbapenem-resistant Enterobacteriaceae (CRE) strains. We found that patients in the multidrug resistance (MDR)-group received more respiratory support than the non-MDR group (40.6% vs 18.2%, P= 0.031) and possessed higher elevated C-reactive protein (62.6% vs 41.8%, P=0.008) and lower haemoglobin (87.5% vs 47.7%, P=0.001). We found that 80.3% (61/76) patients had lung lesions and 57.8% (44/76) patients were immunocompromised within one month. The most common K. pneumoniae strain sequence type was ST23 (15%), followed by ST15 (12.5%) and ST273 (7.5%). Among the strains, 26.25% were classically hypervirulent K1/K2 K. pneumoniae, and all carried salmochelin and rmpA. This study demonstrated the important clinical features, phenotypic and genomic characteristics of isolated strains of PTB patients with K. pneumoniae co-infection. These data suggested a special attention for multidrug resistant K. pneumoniae infections with more obvious inflammatory responses which calls for more respiratory support and timely clinical management.

Magnitude and predisposing factors of intestinal parasitosis and tuberculosis coinfection at five health institutions in Southern Ethiopia: A cross-sectional study.

Intestinal parasites affect the tuberculosis disease outcome by shifting the cell-mediated to humoral immune response and host immune system suppression. However, Mycobacterium tuberculosis (MTB) infection favors the immune escape of parasites. Hence, exploring the rate of intestinal parasitic coinfection with pulmonary tuberculosis (PTB) and its predisposing factors to take better preventive, control, and management measures. A facility-based cross-sectional study was conducted from September to December 2020 at five health institutions in Hawassa city. A total of 214 PTB patients were diagnosed using the GeneXpert assay and enrolled in this study. Demographic, clinical, and risk factors data were collected using a structured questionnaire. Stool samples were collected using a clean, labeled, and leak-proof stool cup. Stool samples were examined using direct saline microscopy and the formal-ether concentration technique. The data were entered and coded in SPSS software for analysis. Bivariate and multivariate logistic regression were employed to identify the associated risk factors. A p-value less than 0.05 was considered statistically significant. The overall rate of intestinal parasitic-MTB coinfection was 36.9%. The most dominant intestinal parasite was Gardia lamblia (17.8%, 38), followed by Entamoeba histolytica/dispar (9.3%, 20). Intestinal parasitosis coinfection of PTB was associated with being rural resident (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.23-4.8), not washing of fruits and vegetables before eating [AOR = 4.14; 95% CI: 1.92-9], being at the early stage of anti-TB treatment [AOR = 3; 95% CI: 1.5-6.3] and presence of chronic diseases [AOR = 7; 95% CI: 3.4-14]. The burden of intestinal parasites-MTB coinfection was high. Those who wash fruits and vegetables before eating should be encouraged, early treatment of PTB patients and avoiding the practice of open-field defecation, especially in rural communities, is necessary. The dual effect of coinfection on disease severity and treatment success needs further cohort study.

Spatiotemporally Comparative Analysis of HIV, Pulmonary Tuberculosis, HIV-Pulmonary Tuberculosis Coinfection in Jiangsu Province, China.

Pulmonary tuberculosis (PTB) is a severe chronic communicable disease that causes a heavy disease burden in China. Human Immunodeficiency Virus (HIV) and PTB coinfection dramatically increases the risk of death. This study analyzes the spatiotemporal dynamics of HIV, PTB and HIV-PTB coinfection in Jiangsu Province, China, and explores the impact of socioeconomic determinants. The data on all notified HIV, PTB and HIV-PTB coinfection cases were extracted from Jiangsu Provincial Center for Disease Control and Prevention. We applied the seasonal index to identify high-risk periods of the disease. Time trend, spatial autocorrelation and SaTScan were used to analyze temporal trends, hotspots and spatiotemporal clusters of diseases. The Bayesian space-time model was conducted to examine the socioeconomic determinants. The case notification rate (CNR) of PTB decreased from 2011 to 2019 in Jiangsu Province, but the CNR of HIV and HIV-PTB coinfection had an upward trend. The seasonal index of PTB was the highest in March, and its hotspots were mainly distributed in the central and northern parts, such as Xuzhou, Suqian, Lianyungang and Taizhou. HIV had the highest seasonal index in July and HIV-PTB coinfection had the highest seasonal index in June, with their hotspots mainly distributed in southern Jiangsu, involving Nanjing, Suzhou, Wuxi and Changzhou. The Bayesian space-time interaction model showed that socioeconomic factor and population density were negatively correlated with the CNR of PTB, and positively associated with the CNR of HIV and HIV-PTB coinfection. The spatial heterogeneity andspatiotemporal clusters of PTB, HIV and HIV-PTB coinfection are exhibited obviously in Jiangsu. More comprehensive interventions should be applied to target TB in the northern part. While in southern Jiangsu, where the economic level is well-developed and the population density is high, we should strengthen the prevention and control of HIV and HIV-PTB coinfection.

Diabetes mellitus-a true immunosuppression

Uncontrolled diabetes mellitus predisposes to variety of infections which are very difficult to manage. Here we report a case of diabetes mellitus with pulmonary tuberculosis who did not respond to anti tubercular therapy (ATT). On further evaluation patient found to have nocardiosis co-infection which usually occurs in immunocompromised patients like malignancy/ in HIV virus infected patients. This patient did not have any such condition other than uncontrolled diabetes mellitus which predisposed to nocardiosis co-infection. This co-infection of pulmonary tuberculosis and nocardiosis is very uncommon in HIV negative individuals and is reported because of this rare presentation.

Case Report: A case report of multiple co-infections (melioidosis, paragonimiasis, Covid-19 and tuberculosis) in a patient with diabetes mellitus and thalassemia-trait in Myanmar

Burkholderia pseudomallei is a soil-dwelling aerobic bacterium prevalent in tropical and subtropical regions, particularly in Southeast Asia and Northern Australia. It is the causal organism of melioidosis, a severe infection that can manifest as chronic debilitating pneumonia resembling pulmonary tuberculosis. Here, we report a case of melioidosis, pulmonary tuberculosis, covid-19, and paragonimus co-infection in a 50-year-old male with poorly controlled diabetes mellitus and β-thalassemia trait. The patient recovered with intravenous antibiotics and standard anti-tuberculosis treatment.

A novel two-codon deletion at codon 508 and 509 of the rpoB gene in pulmonary tuberculosis and HIV co-infection: A case report

We report a case of pulmonary Mycobacterium tuberculosis infection with a resistance to rifampicin (RIF) in a 39-year-old man who was co-infected with Human Immunodeficiency Virus (HIV) and hepatitis C. Phenotypic and genotypic test were performed to diagnose the patient. Sequencing analysis revealed novel two-codon deletion at codon 508 and 509 of the rpoB gene in M. tuberculosis. Keywords: Co-infection, Mycobacterium tuberculosis, rpoB gene, rifampicin-resistant.

Clinical neglect of aspergillosis in pulmonary tuberculosis coinfection: a case report of avoidable mortality in a resourceconstrained setting

Background: Pulmonary aspergillosis (PA) is common among patients with tuberculosis (TB). With both infections presenting with similar clinical and radiologic features, diagnosis of PA is often made too late or missed completely due to lack of clinical suspicion and poor diagnostic laboratory capacity for mycotic infections prevalent in our settings. We present a case of preventable mortality caused by delayed diagnosis and treatment of PA in a patient with pulmonary TB (PTB).
 Case presentation: A 13-year-old female was diagnosed and treated for PTB, having received anti-TB regimen for 8 months in a mission hospital from where she was referred due to worsening cough, chest pain and progressive breathlessness. The patient was re-assessed and investigated, with GeneXpert detecting Mycobacterium tuberculosis, susceptible to rifampicin. Diagnosis of pulmonary tuberculosis complicated by right pneumothorax was made indicating an emergency thoracotomy and chest tube insertion and continuation of the first line anti-TB regimen. At about 2 weeks into admission, patients had features of superimposed acute bacterial sepsis with fever becoming high grade, marked neutrophilia with toxic granulation and elevated sepsis biomarker, and this necessitated empiric antibiotic treatment with parenteral meropenem and vancomycin. However, the patient only had mild clinical improvement following which there was progressively worsening respiratory symptoms and massive haemoptysis. Result of sputum fungal study was available on admission day 20 and revealed a growth of Aspergillus flavus. Treatment with intravenous voriconazole was however commenced rather late when the fungal respiratory disease could no longer be remedied. The patient died on admission day 23.
 Conclusion: Diagnosis of PA in patients with background TB is often made too late to guarantee timely and effective antifungal treatment with negative consequences on patients’ outcomes. Improving clinical and laboratory capacities is essential to reducing mortality from PA in healthcare facilities.

The lung microbiome in HIV-positive patients with active pulmonary tuberculosis

Tuberculosis poses one of the greatest infectious disease threats of our time, especially when associated with human immunodeficiency virus (HIV) infection. Very little data is available on the lung microbiome in pulmonary tuberculosis (PTB) in HIV-positive patients. Three patient cohorts were studied: (i) HIV-positive with no respiratory disease (control cohort), (ii) HIV-positive with pneumonia and (iii) HIV-positive with PTB. Sputum specimens were collected in all patients and where possible a paired BALF was collected. DNA extraction was performed using the QIAamp DNA mini kit (QIAGEN, Germany) and extracted DNA specimens were sent to Inqaba Biotechnical Industries (Pty) Ltd for 16S rRNA gene sequence analysis using the Illumina platform (Illumina Inc, USA). Data analysis was performed using QIMME II and R Studio version 3.6.2 (2020). The lung microbiomes of patients with PTB, in the context of HIV co-infection, were dominated by Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes. Loss of biodiversity and dysbiosis was found in these patients when compared to the HIV-positive control cohort. Microbial community structure was also distinct from the control cohort, with the dominance of genera such as Achromobacter, Mycobacterium, Acinetobacter, Stenotrophomonas and Pseudomonas in those patients with PTB. This is the first study to describe the lung microbiome in patients with HIV and PTB co-infection and to compare findings with an HIV-positive control cohort. The lung microbiomes of patients with HIV and PTB were distinct from the HIV-positive control cohort without PTB, with an associated loss of microbial diversity.

Case Report: A case report of multiple co-infections (melioidosis, paragonimiasis, Covid-19 and tuberculosis) in a patient with diabetes mellitus and thalassemia-trait in Myanmar

Burkholderia pseudomallei is a soil-dwelling aerobic bacterium prevalent in tropical and subtropical regions, particularly in Southeast Asia and Northern Australia. It is the causal organism of melioidosis, a severe infection that can manifest as chronic debilitating pneumonia resembling pulmonary tuberculosis. Here, we report a case of melioidosis, pulmonary tuberculosis, covid-19, and paragonimus co-infection in a 50-year-old male with poorly controlled diabetes mellitus and β-thalassemia trait. The patient recovered with intravenous antibiotics and standard anti-tuberculosis treatment.

Neutrophils and lymphocytes in relation to MMP-8 and MMP-9 levels in pulmonary tuberculosis and HIV co-infection

BackgroundMatrix metalloproteinase (MMP) activity has an important role in lung cavitary formation occurred in pulmonary tuberculosis (TB). Low number and viability of CD4 + T-lymphocytes in patients with TB/HIV co-infection leads to impaired neutrophils production, causing further impaired MMPs production. ObjectiveTo explore association of neutrophils and lymphocytes count to MMP-8 and MMP-9 among pulmonary TB patients with cavitary lesion and HIV co-infection. MethodsWe conducted a cross-sectional study using a purposive sampling technique among patients with non-cavitary TB (n = 50), cavitary TB (n = 50) and TB/HIV (n = 27). Complete blood count was examined, including neutrophils and lymphocytes count. MMP-8 and MMP-9 were measured from plasma samples using ELISA method. Statistical analysis was conducted to determine the relation between neutrophils, lymphocytes and MMPs. ResultMMP-8 and MMP-9 were positively correlated with neutrophils, but not to lymphocytes in all groups. Neutrophils, lymphocytes, and MMP-9 were significantly lower in TB/HIV co-infection, whereas MMP-8 was higher compared to new pulmonary TB. Interestingly, in cavitary TB, low lymphocytes were significantly correlated with higher level of MMP-8 and larger extent of lung affected. ConclusionMMP-8 and MMP-9 are associated with neutrophil count, suggesting that neutrophils contribute significantly to their secretion. MMP-8 is significantly higher in TB/HIV co-infection and extent of lung damage in cavitary TB with lower lymphocyte count. This study suggests that lower lymphocyte level is related to higher neutrophil orchestrated inflammation, leading to tissue destruction.

Coinfection of pulmonary tuberculosis with other lower respiratory tract infections: A retrospective cross-sectional study.

Little attention has been given to the development of lower respiratory tract infections (LRTIs) in patients with pulmonary tuberculosis (PTB) during their anti-tuberculosis (anti-TB) treatment and how that might affect patients' health status. Here, the prevalence and etiologies of other LRTIs in a cohort of PTB patients were determined, and the clinical features and outcomes were described. Adult patients with PTB between 2015 and 2020 were recruited and monitored during their anti-TB treatment for the presence of LRTIs. Clinical data were retrospectively collected from patients' medical records. Data from 76 PTB patients (57 [75%] males) were reviewed. The median age was 61.0 (interquartile range 83.5-35.5) years, and other LRTIs were detected in 45 (59.2%) PTB patients. Of the 126 episodes of LRTIs, 84 (66.7%) were due to bacterial infections, 37 (29.4%) were due to fungal infections, and 5 (3.9%) were due to viral infections. The development of LRTIs was significantly more common in older (P = 0.012) and hypertensive patients with PTB (P = 0.019). Patients with PTB and LRTIs experienced significantly more frequent extrapulmonary infections (P = 0.0004), bloodstream infections (P = 0.001), intensive care unit stays (P = 0.001), and invasive mechanical ventilation use (P = 0.03) than patients who did not develop LRTI. The identification of host-related risk factors for LRTI development among patients with PTB could be used to develop a prediction model for LRTI development. Hence, initiating antimicrobials early, in parallel with appropriate anti-TB treatment, may mitigate PTB-related health and economic consequences.

Characteristics of T lymphocyte content according to oxidative stress and antioxidant activity in patients with pulmonary tuberculosis and COVID-19 infection

In order to study the particularities of T lymphocyte content depending on the indicators of oxidative stress and antioxidant activity, in patients with pulmonary tuberculosis in association with COVID-19 coinfection, 42 patients were examined, of which: a) baseline - 21 patients with pulmonary tuberculosis and co-infection COVID-19, b) control group - 21 patients with pulmonary tuberculosis. At the patients included in the study, there were determined the leukocyte formula, the level of CD3, CD4, CD8 lymphocytes, the oxidative stress reaction as well as the antioxidant activity. As a result, it was determined that at patients with tuberculosis and COVID-19 coinfection: as the content of lymphocytes, and in particular, T lymphocytes decreases at patients with pulmonary tuberculosis and COVID-19 co-infection, the degree of oxidative damage of proteins and the predisposition of lipoproteins to oxidation increases significantly according to the data of the AOPP marker and the indicator of malonic dialdehyde of oxidative stress (malonic dialdehyde - DAM), which indicates the severity of oxidative stress reactions at these patients. The total antioxidant activity, determined by the ATS method at patients with pulmonary tuberculosis and COVID-19 co-infection, was significantly reduced, and according to the CUPRAC method it increased significantly as the content of lymphocytes and, in particular, lymphocytes decreased. The enzyme superoxide dismutase (SOD), catalase and the activity of the antioxidant protein ceruloplasmin at patients with pulmonary tuberculosis and COVID19 decreased significantly as the content of lymphocytes and, in particular, T lymphocytes decreased. Thus, the parameters of oxidative stress and antioxidant activity can be considered potential biomarkers markers of the evolution of pulmonary tuberculosis in association with COVID-19 infection.

Pulmonary Tuberculosis and COVID-19 Coinfection: Hickam's Dictum Revisited

Pulmonary Tuberculosis and COVID-19 Coinfection: Hickam's Dictum Revisited

Status and Outlook of Pulmonary Tuberculosis Co-Infection

Status and Outlook of Pulmonary Tuberculosis Co-Infection

LATENT MYCOBACTERIUM TB REACTIVATION IN TWO PATIENTS WITH COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Since December 2019, the world has been suffering from the pandemic of the new coronavirus (COVID-19) with a significant mortality rate. It mainly affects the respiratory system with a wide severity range from being asymptomatic to causing severe acute respiratory distress syndrome (ARDS). Few case reports have reported pulmonary tuberculosis co-infection or reactivation in COVID-19 pneumonia patients(1-2). We present two cases of COVID-19 pneumonia who presented, after the resolution of the acute symptoms, with shortness of breath and were found to have pulmonary cavities, suspicious for tuberculosis (TB). CASE PRESENTATION: Case 1: 76-year-old Brazilian male with multiple comorbidities including COPD on home oxygen, who received the monoclonal antibody infusion (Bamlanivimab) a month ago for mild COVID-19 pneumonia, presented with generalized weakness associated with fever and cough. CT chest showed extensive peribronchiolar and centrilobular patchy and nodular opacities with internal cavities (Figure 1 Right). A previous chest x-ray showed left basal lung scarring (Figure 1 left). Case 2: 71-year-old Columbian male with a history of diabetes mellitus and COVID-19 pneumonia treated with dexamethasone and remdesivir for 10 days, presented 3 months later with dyspnea, fever, and productive cough. X-ray and CT chest showed diffuse nodular opacities with dense consolidation in both upper lobes associated with areas of cavitations (Figure 2 Right). A previous chest x-ray did not show any evidence of prior lung pathologies (Figure 2 Left). Bronchial washing PCR was positive for mycobacterium tuberculosis in both cases. DISCUSSION: Cavitary lung lesions are usually caused by mycobacterial, fungal, neoplastic, or autoimmune pathologies. Viral pneumonia, including SARS-CoV and MERS-CoV, is not a common cause of lung cavities even in severe viral infections (3). Although few case reports have reported cavitary lesions as sequelae of COVID-19 pneumonia, common causes should be excluded first. The two most common CT chest findings in COVID-19 patients are ground-glass opacities and bilateral patchy shadowing (4). The presence of lung cavities in such patients should raise the suspicion of TB, especially in high-risk patients. Whether or not the immune system reaction to the COVID-19; including leukopenia, lymphopenia, and an inflammatory cytokine storm can lead to latent TB reactivation is not fully understood yet. However, treatment of COVID-19 with immunosuppressant drugs such as corticosteroids could be a risk factor for TB reactivation. Both of our patients had new lung cavitary lesions with confirmed mycobacterial infection. CONCLUSIONS: Pulmonary cavities in COVID-19 pneumonia patients should raise the suspicion of other pathologies such as tuberculosis, especially in high-risk patients. REFERENCE #1: 1.Tham, S.M., et al., Four Patients with COVID-19 and Tuberculosis, Singapore, April-May 2020.Emerg Infect Dis, 2020. 26(11): p. 2764-2766.10.1056/NEJMoa2002032. REFERENCE #2: 2. Torre, A., et al., Preliminary observations on IGRA testing for TB infection in patients with severe COVID-19 eligible for immunosuppressive therapy. Respir Med, 2020. 175: p. 106204. REFERENCE #3: 3. Zoumot Z, et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 21, 24 (2021). https://doi.org/10.1186/s12890-020-01379-14. Guan WJ, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-1720. DOI: 10.1056/NEJMoa2002032. DISCLOSURES: No relevant relationships by Sherif Elkattawy, source=Web Response No relevant relationships by Muhammad Atif Noori, source=Web Response No relevant relationships by onyeka Nwachukwu, source=Web Response No relevant relationships by John Viechweg, source=Web Response No relevant relationships by Islam Younes, source=Web Response

Risk Factors for Mortality among HIV/AIDS Patients

Background: Morbidity and mortality of HIV/AIDS infections is still high and as a global health problem particularly in Low-Middle Income Countries (LMICs). Indonesia ranks third in Asia Pacific in increasing HIV infection. A Study on risk factors for mortality in HIV/AIDS patients in Dr. Kariadi General Hospital has never been conducted. This study analyzed the risk factors for mortality among HIV/AIDS patients.Methods: Case control study, data from medical records of inpatients and outpatients in Dr. Kariadi General Hospital from January 2015 to December 2017.Results: Study subject: Two hundred and ten HIV/AIDS patients, were included; 105 (56.75%) as cases and 105 (9.65%) control patients. The significant risk factors for mortality were as follow: male sex (p = 0.030); age ≥ 45 years (p = 0.035); non compliance to treatment (p = 0,000); WHO clinical stage III and IV (p = 0,000); co-infection of pulmonary tuberculosis (p = 0,000); CD4 cell count < 200 cells/mm3 (p = 0,000); eGFR < 60 mL/minute/1.72 m2 (p = 0.001) and Haemoglobin level < 10 g/dL (p = 0.008). The non-significant risk factors for mortality were as follow: level of education (p = 0.650); Hepatitis B co-infection (p = 0.153) and Hepatitis C co-infection (p = 0.506). The most important risk factors for mortality in this study in were non compliance to treatment (p = 0.003; OR = 3.285) and CD4 count < 200 cells/mm3 (p = 0.014; OR = 5.480).Conclusion: In this study, the risk factors for mortality in HIV/AIDS patients were male sex; age ≥ 45 years; non compliance to treatment; WHO clinical stage III and IV; co-infection of pulmonary tuberculosis, CD4 count < 200 cells/mm3; eGFR < 60 mL/minute/1.72 m2 and Hb level < 10 g/dL. The most important risk factors for mortality were non compliance to treatment and CD4 count < 200 cells / mm3.

Study the prevalence of Pulmonary Tuberculosis and HIV co-infection in all Pulmonary Tuberculosis patients at tertiary health care centre

Background: Co-infection of Human Immunodeficiency Virus (HIV) and tuberculosis(TB) is considered to be one of the emerging medical conditions responsible for huge social and economic burden globally. Tuberculosis is leading cause of mortality among people living with HIV/AIDS. Methodology: The present cross-sectional study was carried out in a tertiary care centre of a city in Maharashtra between the periods of 1st August 2019 to July 2020. Study population were IPD patients from department of pulmonary medicine of tertiary health care centre. Sampling technique: Every fifth PTB diagnosed patient admitted in ward of pulmonary medicine department was included in the study till the sample size was achieved. The data was entered to excel sheet and analyzed by Windows 10 excel software. Result: study subjects were from age group 16-30 years of age, in this age group 2 (0.75%) patient was co-infected with PTB and HIV. 86(32.33%) study subjects were from age group 31 – 45 years of age from this age group 8 (3.00%) patients were HIV PTB co-infected. 2(0.75%) patient was there in age group 13-15 years of age. Symptoms of study subjects in PTB with HIV patients most common symptoms were weight loss(100%), Loss of appetite(100%) and evening rise of fever (85.71%).While in PTB without HIV patients loss of appetite evening rise of fever and weight loss was most common symptoms. In patients of PTB and HIV co-infection, sputum smear positive rate was lower, 6 out of 14 patients (42.86%) as compared to patients without PTB and HIV co-infection, 148 out of 252(i.e., 58.73%). Conclusion: It can be concluded from our study that there is difference n demography of HIV co-infection with Tuberculosis also it differed in clinical and radiological features also we have noted that the mortality of HIV –TB co-infection was having higher mortality i.e. 14.28% as compared to without co-infection i.e. 3.96%, hence prompt treatment by antiviral drugs and timely screening for TB and timely treatment is mandatory.