Analysis of lethal outcomes in patients with newly-diagnosed tuberculosis of the respiratory organs in combination with HIV-infection
- Authors: Zimina V.N.1, Kravchenko A.V.2, Zyuzya Y.R.3, Batyrov F.A.3, Popova A.A.2, Klimov G.V.3, Parkhomenko Y.G.4, Vasil'eva I.A.1, Zimina VN5, Kravchenko AV6, Zyuzya Y.R7, Batyrov FA7, Popova AA6, Klimov GV7, Parkhomenko Y.G8, Vasilieva IA5
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Affiliations:
- ГУ Центральный НИИ туберкулеза PAMH
- ФГУН Центральный НИИ эпидемиологии Роспотребнадзора
- Туберкулезная клиническая больница № 7
- ГУ НИИ морфологии человека РАМН
- Central Research Institute of Tuberculosis, Moscow
- Central Research Institute of Epidemiology, Moscow
- Tuberculosis hospital N 7, Moscow
- Research Institute of Human Morphology, Moscow
- Issue: Vol 83, No 11 (2011)
- Pages: 25-31
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/30924
- ID: 30924
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Full Text
Abstract
Material and methods. Of 304 HIV patients with newly-diagnosed tuberculosis treated in Moscow Tubercusis Hospital N 7 in 2006-2010, 40 (13.2%) patients died. Tuberculosis diagnosis was made after detection of M.tuberculosis (MT) by different tests, MT DNA in different biological material, histological verification or by effectiveness of specific antituberculous therapy. Postmortem examinations were made according to the protocol.
Results. Significant differences were detected in patients with initial count of CD4+ lymphocytes less than 50 in 1 mcl. Specific CNS affection was found in patients with initial lymphocyte count CD4+ less than 100 in 1 mcl. Most of autopsy examinations registered generalized acutely progressive tuberculosis with multiple lesions of internal organs and lymph nodes (LN). Microscopy revealed obscure morphological picture of specific inflammation with prevalence of alternative-exudative tissue reactions in the absence of a productive inflammation component. Cases with submiliary dissemination which was invisible in macroscopic examination due to a bright picture of exudative tissue reaction (rare plethora of the lungs, alveolar and interstitial edema, perifocal inflammatory reaction of nonspecific reactive nature) and small size of the lesions. The comparison of clinical and autopsy diagnoses revealed that involvement of intrathoracic LN and miliary dissemination, according to autopsy, occurred much more frequently than shown by antemortem standard x-ray examination of the chest.
Conclusion. It is strongly recommended to perform computed tomography of the chest in all HIV-infected patients with long-term fever but without visible alterations on chest x-ray.
Keywords
About the authors
Vera Nikolaevna Zimina
ГУ Центральный НИИ туберкулеза PAMH
Email: vera-zim@yandex.ru
канд. мед. наук, ЦНИИ туберкулеза РАМН, докторант отд. фтизиатрии; ГУ Центральный НИИ туберкулеза PAMH
Aleksey Viktorovich Kravchenko
ФГУН Центральный НИИ эпидемиологии Роспотребнадзора
Email: kravtchenko@hivrussia.net
д-р мед. наук, проф., вед. науч. сотр. СНИО ЭП СПИД ФГУН ЦНИИЭ Роспотребнадзора, тел.: 8-495-366-05-18; ФГУН Центральный НИИ эпидемиологии Роспотребнадзора
Yuliya Rashidovna Zyuzya
Туберкулезная клиническая больница № 7канд. мед. наук, врач-патологоанатом ТКБ № 7; Туберкулезная клиническая больница № 7
Farit Akhatovich Batyrov
Туберкулезная клиническая больница № 7
Email: tkb7@mosgorzdrav.ru
д-р мед. наук, проф., гл. врач ТКБ № 7, тел.: 8-499-268-66-30; Туберкулезная клиническая больница № 7
Anna Anatol'evna Popova
ФГУН Центральный НИИ эпидемиологии Роспотребнадзора
Email: asya_med.ророvа@yandex.ru
канд. мед. наук, науч. сотр. СНИО ЭП СПИД ФГУН ЦНИИЭ Роспотребнадзора; ФГУН Центральный НИИ эпидемиологии Роспотребнадзора
Grigoriy Vladimirovich Klimov
Туберкулезная клиническая больница № 7
Email: grea75@mail.ru
зав. рентгенологическим отд-нием ТКБ № 7, тел. 8-499-268-60-82; Туберкулезная клиническая больница № 7
Yuriy Georgievich Parkhomenko
ГУ НИИ морфологии человека РАМН
Email: morfolhum@mail.ru
д-р мед. наук, проф., зав. лаб. инфекционной патологии ГУ НИИ морфологии человека РАМН, зав. патолого-анатомическим отд-нием инфекционной клинической больницы № 2, тел.: 8-495-365-23-07; ГУ НИИ морфологии человека РАМН
Irina Anatol'evna Vasil'eva
ГУ Центральный НИИ туберкулеза PAMH
Email: vasil39@list.ru
д-р мед. наук, зав. отд. фтизиатрии ЦНИИ туберкулеза РАМН; ГУ Центральный НИИ туберкулеза PAMH
V N Zimina
Central Research Institute of Tuberculosis, MoscowCentral Research Institute of Tuberculosis, Moscow
A V Kravchenko
Central Research Institute of Epidemiology, MoscowCentral Research Institute of Epidemiology, Moscow
Yu R Zyuzya
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
F A Batyrov
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
A A Popova
Central Research Institute of Epidemiology, MoscowCentral Research Institute of Epidemiology, Moscow
G V Klimov
Tuberculosis hospital N 7, MoscowTuberculosis hospital N 7, Moscow
Yu G Parkhomenko
Research Institute of Human Morphology, MoscowResearch Institute of Human Morphology, Moscow
I A Vasilieva
Central Research Institute of Tuberculosis, MoscowCentral Research Institute of Tuberculosis, Moscow
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