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Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease
Author(s) -
Heyderman R. S.,
Makunike R.,
Muza T.,
Odwee M.,
Kadzirange G.,
Manyemba J.,
Muchedzi C.,
Ndemera B.,
Gomo Z. A. R.,
Gwanzura L. K. Z.,
Mason P. R.
Publication year - 1998
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1046/j.1365-3156.1998.00167.x
Subject(s) - medicine , tuberculosis , pleural effusion , pleural disease , gastroenterology , prospective cohort study , surgery , pathology , respiratory disease , lung
objective To elucidate the relationship between HIV, CD4 1 count and pleural TB. method In a prospective study, 94 patients presenting at two large Harare hospitals with clinically suspected pleural TB were enrolled over a 10‐month period. All underwent standardized evaluation, closed pleural aspiration and biopsy. Patients receiving directly observed anti‐TB therapy were followed‐up. results Pleural TB was diagnosed in 90 individuals (median age 33 years; range 18‐65; 64 males); the seroprevalence of HIV was 85%. HIV‐positive patients were older than HIV‐negative individuals (median age 33 vs 23 years, P = 0.013) and had a significantly lower median CD4 1 count (191 vs 1106 × 10 6 /l respectively, P = 0.004). A CD4 1 count of <200 × 10 6 /l was associated with a length of illness >30 days (65% vs 37%; P = 0.05), a positive pleural fluid smear (37% vs 0%; P = 0.0006) and a positive pleural biopsy Ziehl‐Neelsen stain (35% vs 7%; P = 0.021). However, a relationship between CD4 1 count and either pleural granuloma formation or radiological evidence of disseminated disease was not observed. conclusion In sub‐Saharan Africa, TB pleural effusions have become associated with older age, a chronic onset, and an increased mycobacterial load. These data emphasize the complex relationship between pleural TB, HIV infection and a low CD4 1 count.