TB disease patterns by HIV and diabetes status
METHODS: This was a prospective cohort study using point-of-care ultrasound (POCUS) in Indian patients with presumed TB. Clinical and imaging data were used to develop refined case definitions for PTB, concurrent PTB and EPTB (PTB + EPTB) and EPTB without PTB (EPTB). These groups were analysed by HIV (HIV+/–) and diabetes mellitus (DM+/–) status.
RESULTS: Of 172 HIV–/DM– patients with TB, 48% had PTB, 23% PTB + EPTB and 29% had EPTB, totalling 52% with any EPTB (PTB + EPTB or EPTB). In HIV+/DM– patients with TB (n = 35), 6% had PTB, 40% had PTB + EPTB and 54% had EPTB, accounting for 94% with EPTB. In HIV–/DM+ patients with TB (n = 61), 61% had PTB, 28% had PTB + EPTB and 11% had EPTB, representing 39% with EPTB.
CONCLUSION: Refined case definitions revealed high proportions of EPTB even without HIV or DM. HIV further altered the TB disease pattern towards EPTB and DM towards PTB. Therefore, the dichotomy between PTB or EPTB does not represent the actual spectrum of TB disease. EPTB should receive higher priority in research and clinical practice.
Document Type: Research Article
Affiliations: 1: University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany 2: Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany 3: Lighthouse Clinic Lilongwe, Kamuzu Central Hospital, Mzimba, Lilongwe, Malawi 4: Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India 5: Department of Pulmonary Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India 6: Department of Radiodiagnosis, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India 7: University Hospital Heidelberg, Division for Infectious Diseases and Tropical Medicine, Heidelberg, Germany, German Center of Infection Research, Partner Site Heidelberg University Hospital, Heidelberg, Germany 8: University Clinics Mainz, Department of Paediatrics, Mainz, Germany 9: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany, German Center for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany 10: Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India, Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
Publication date: August 1, 2022
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