Disseminated tuberculosis and human immunodeficiency virus infection

LETTER TO THE EDITOR

Disseminated tuberculosis and human immunodeficiency virus infection

Syed Ahmed Zaki

Assistant Professor, Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

^{Correspondence to}

Dear Editor,

I read with interest the recent case on severe disseminated tuberculosis in a 4-year-old girl by Rey et al.,¹ and have the following comments to offer:

Human immunodeficiency virus (HIV) testing was not done in the case described by the authors. As per the World Health Organization, more than 39 million people worldwide were living with HIV infection at the end of 2004.² More than 90% of HIV-infected individuals live in developing countries. Thus, in the current era of HIV, one needs to rule it out in all cases of disseminated tuberculosis. Although the treatment for disseminated tuberculosis is the same for seropositive and seronegative patients, certain point merits consideration:

1) Seropositive patients are more likely to present with disseminated tuberculosis as compared to seronegative patients.³ Disseminated tuberculosis has been accepted as an AIDS-defining criterion. The WHO clinical staging of HIV/AIDS is used in many countries to determine eligibility for antiretroviral therapy, particularly in settings in which CD4 testing is not available. Presence of disseminated tuberculosis puts a patient in stage 4 which is an indication for starting ART.⁴ WHO recommends HIV testing for patients of all ages in whom tuberculosis is suspected or already confirmed.

2) Paradoxical reactions occur more frequently in seropositive as compared to seronegative patients. They are triggered by the reconstitution of immune response, either as a result of antiretroviral therapy or of the tuberculosis treatment itself. These include: appearance of new lymph nodes or an increase in the size of existing lymph nodes; worsening of central nervous system lesions; and increase in pleural effusion.⁵

Through this letter, I would like to re-emphasize our readers that HIV testing should be done in all cases of disseminated tuberculosis.

Submitted on: 03/25/2011

Approved on: 03/30/2011

We declare no conflict of interest.

• 1. Rey LC, Sousa AQ. Severe disseminated tuberculosis in a 4-year-old girl. Braz J Infect Dis 2010; 14:639-40.
• 2. Yogev R, Chadwick EG. Acquired Immunodeficiency Syndrome (Human Immunodeficinecy Virus). In: Behrman RE, Kliegman RM, Jenson HB, Stanton FB editors. Nelson Textbook of Pediatrics, 18th ed. Philadelphia: WB Saunders; 2008. p. 1427-1443.
• 3. Small PM, Selcer UM. Human Immunodeficiency Virus and Tuberculosis. In: Schlossberg D, editor. Tuberculosis and Nontuberculous Mycobacterial Infections. 4^th ed. Philadelphia: W.B Saunders Company; 1999. p. 332-4.
• 4. Hare CB. WHO Staging System for HIV Infection and Disease in Adolescents and Adults, Table 3; Clinical Overview of HIV Disease. In: Peiperl L, Coffey S, Volberding PA, editors. HIV InSite Knowledge Base [textbook online]. San Francisco: UCSF Center for HIV Information; 2006. Available at: http://www.hivinsite.ucsf.edu/InSite?page=kb-03-01-01 [Last accessed on 2010 March 25]
• 5. Zaki SA, Shanbag P. Pulmonary tuberculosis with meningitis. J Pediatr Infect Dis 2008; 3:289-90.

Publication Dates

• Publication in this collection
  17 Oct 2011
• Date of issue
  Oct 2011