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Background  Disseminated mycobacterial disease is an important cause of morbidity and mortality in patients with HIV-infection. Nonspecific clinical presentation makes the diagnosis difficult and sometimes neglected.    Methods  We conducted a retrospective cohort study to compare the presentation of disseminated Mycobacterial tuberculosis (MTB) and  non-tuberculous Mycobacterial  (NTM) disease in HIV-positive patients from 1996 to 2006 in Brazil.    Results  Tuberculosis (TB) was diagnosed in 65 patients (67.7%) and NTM in 31 (32.3%) patients. Patients with NTM had lower CD4 T cells counts (median 13.0 cells/mm 3   versus  42.0 cells/mm 3 , P = 0.002). Patients with tuberculosis had significantly more positive acid-fast smears (48.0%  vs  13.6%, P = 0.01). On chest X-ray, miliary infiltrate was only seen in patients with MTB (28.1%  vs . 0.0%, P = 0.01). Pleural effusion was more common in patients with MTB (45.6%  vs . 13.0%, P = 0.01). Abdominal adenopathy (73.1%  vs . 33.3%, P = 0.003) and splenic hypoechoic nodules (38.5%  vs . 0.0%, P = 0.002) were more common in patients with TB.    Conclusion  Miliary pulmonary pattern on X-ray, pleural effusion, abdominal adenopathy, and splenic hypoechoic nodules were imaging findings associated with the diagnosis of tuberculosis in HIV-infected patients. Recognition of these imaging features will help to distinguish TB from NTM in AIDS patients with fever of unknown origin due to disseminated mycobacterial disease.

bmc infectious diseases

Comparative radiological features of disseminated disease due to Mycobacterium tuberculosis vs non-tuberculosismycobacteria among AIDS patients in Brazil