Pleural tuberculosis in Harare, Zimbabwe: the relationship between human immunodeficiency virus, CD4 lymphocyte count, granuloma formation and disseminated disease
objective To elucidate the relationship between HIV, CD41 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 CD41 count (191 vs 1106 × 106/l respectively, P= 0.004). A CD41 count of <200 × 106/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 CD41 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 CD41 count.
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Document Type: Research Article
Publication date: 1998-01-01