Document 0164
 DOCN  M9590164
 TI    [Tuberculosis presenting as diffuse pulmonary infiltrates in AIDS
       patients: diagnostic performance of clinical samples]
 DT    9509
 AU    Moreno S; Hermida JM; Buzon L; Parras F; Fortun J; Bouza E; Servicio de
       Microbiologia Clinica/Unidad de Enfermedades; Infecciosas-VIH. Hospital
       General Gregorio Maranon.
 SO    Enferm Infecc Microbiol Clin. 1995 May;13(5):297-300. Unique Identifier
       : AIDSLINE MED/95298865
 AB    BACKGROUND: In patients with human immunodeficiency virus (HIV)
       infection, tuberculosis is frequently presented with diffuse pulmonary
       infiltrates which are indistinguishable from those caused by other
       respiratory pathogens. It is therefore useful to know the diagnostic
       performance of different clinical samples. METHODS: We have
       retrospectively analyzed the clinical histories of 56 patients seen over
       a 3-year period. All the patients had HIV infection, Mycobacterium
       tuberculosis isolated in at least one clinical sample and presented with
       diffuse bilateral infiltrates in thorax radiography. The results of all
       the clinical samples submitted to the microbiology laboratory. RESULTS:
       The highest performance in both stainings and cultures were obtained
       from the biopsy (or aspirate) of adenopathies (93 and 100%,
       respectively), sputum (57 and 88%) and urine (31 and 64%). A lower than
       expected sensitivity was obtained in the fibrobronchoscopy samples
       (bronchoalveolar lavage and transbronchial biopsy). The staining had low
       sensitivity for predicting positive cultures in all the samples except
       in the adenopathies. Visualization of granulomas in transbronchial
       biopsies and bone marrow was more sensitive for diagnosis than the
       demonstration of resistant acid-alcohol bacilli in the same samples.
       Globally, rapid diagnosis was obtained in 43 patients (76%). The
       remaining 13 (24%) patients were not diagnosed until the culture results
       had been received despite the adequate use of diagnostic procedures.
       CONCLUSIONS: These findings support the use of empiric treatment when
       tuberculosis is suspected despite initial negativity of the
       microbiologic and pathologic examinations following the discarding of
       other potential causes.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/PATHOLOGY
       Cytodiagnosis  English Abstract  Female  Human  Male  Mycobacterium
       tuberculosis/ISOLATION & PURIF  Retrospective Studies  Thoracic
       Radiography  Tuberculosis/*DIAGNOSIS/PATHOLOGY  JOURNAL ARTICLE

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