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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

HIV-associated tuberculosis (TB) poses an immediate and serious threat to public health, especially in the developing world. Moreover, atypical clinical presentation and unfavorable outcome have been observed in HIV-infected patients with TB. The authors report their findings from an investigation of the impact of HIV infection upon the clinical presentation, response to treatment, and outcome of pulmonary TB. The symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome, and adverse reactions of 88 HIV-infected patients seen during January-October 1993 at the Central Chest Hospital, Nonthaburi, Thailand, with newly-diagnosed, culture-proven, untreated pulmonary TB were compared with those of age- and gender-matched HIV-seronegative patients. There were 82 men and six women in each group of mean age 35.6 years, with the majority being aged 16-40. Heterosexual contact was the most common risk factor for HIV infection, with homosexuality implicated in only 1% of all cases of infection. No difference was observed between the two groups in the frequency of pyrexia, dyspnoea, cough, or hemoptysis, although cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group. Direct smear positivity was comparable in the two groups. Resistance rates to anti-TB drugs were not different except for Streptomycin which was higher among the HIV-infected patients. Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, but the difference was not statistically significant. Default was much higher among the HIV-infected, although the culture conversion rate was satisfactory among those who completed treatment. Twelve HIV-infected patients died during the course of treatment, four due to TB. The authors that their findings lead physicians to suspect TB among HIV-seropositive patients and provide them with the appropriate and timely short-course chemotherapy.
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PMID:Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre. 774 73

A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9%) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3%) and miliary TB (14; 21%) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6%) and lymphadenopathy (17; 25.4%) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3%) and TB/DM (20; 29%) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8%) than TB/HIV (13; 19.4%) (p<0.05). A success rate of 15 (21.7%) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4%) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients.
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PMID:Tuberculosis: a resurgent disease in immunosuppressed patients. 1754 73