A Simple Algorithm for the Diagnosis of AIDS-Associated Genitourinary Tuberculosis

TO THE EDITOR—As has been shown in surveys in Canada, the United Kingdom, and the United States, genitourinary tuberculosis (TB) is a common form of nonpulmonary TB, accounting for 27% (range, 14%–41%) of the extrapulmonary TB cases [1]. Among patients with AIDS, the incidence of genitourinary TB may be even higher. In an autopsy study in India, 24 of 35 kidneys from patients who died of AIDS showed evidence of infection, including 17 cases of TB [2]. In a similar study in Mexico City, renal disease was demonstrable in 87 (63%) of 138 autopsies performed on patients with AIDS; infection was the cause of the renal disease in 36 cases, with 19 being due to Mycobacterium tuberculosis [3]. However, no data of the prevalence of genitourinary TB in living patients with AIDS can be found in the literature. TB of the urinary tract is easily overlooked. The disease is very slow to progress, with minimal and subtle symptoms, and the signs and symptoms mimic those of other infections of the kidney [4].