RESUMEN
BACKGROUND: Separate risk factors for HIV infection and for tuberculosis (TB) are well-studied, but it is unclear whether these risk factors still apply in the new epidemiologic situation of dual infection. This study examines risk factors associated with seropositivity for HIV in Ethiopian children with clinical TB. METHODS: A prospective, controlled study of children with TB diagnosed in Addis Ababa from December 11, 1995, to January 28, 1997, in which HIV-positive children were compared with HIV-negative children with regard to sociodemographic background, previous medical history and vaccination. RESULTS: HIV prevalence among children with clinical TB was 11.2%. High educational status of mothers, low age, loss of one or two parents and earlier Calmette-Guérin bacillus (BCG) vaccination of the child were factors independently related to HIV infection. CONCLUSION: Factors associated with HIV infection among children with clinical TB include higher education of parents, higher income and better living conditions. The HIV epidemic might thus modify traditional risk factors for tuberculosis. It might also decrease the overall effect of BCG vaccination given that BCG did not provide protection in children infected with HIV. An expected increase of dually infected children who are younger, more in need of hospitalization and often lacking one or both parents will put an additional burden on the Ethiopian health care system.
Asunto(s)
Infecciones por VIH/complicaciones , Tuberculosis/complicaciones , Adolescente , Vacuna BCG , Niño , Preescolar , Escolaridad , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Tuberculosis/epidemiología , Tuberculosis/inmunologíaRESUMEN
Sputum microscopy for acid-fast bacilli (AFB), although relatively insensitive, is still the cornerstone of tuberculosis (TB) diagnosis in the developing world. Its diagnostic value has been eroded owing to the increasing number of HIV-related smear-negative pulmonary TB cases. Concentration of sputum by centrifugation after liquefaction with sodium hypochlorite is a possible means of increasing the sensitivity of direct microscopy. This procedure has been studied recently in developing countries although with conflicting results. The aim of our study, performed in 1996 in Addis Ababa, Ethiopia, was to evaluate the sensitivity of the concentration method in a large cohort of consecutive patients with suspected pulmonary TB. We show that the overall sensitivity increased from 54.2% using conventional direct microscopy to 63.1% after concentration (P < 0x0015). In HIV-positive patients, sensitivity increased from 38.5% before to 50.0% after concentration (P < 0x0034). The significant increase in yield of AFB in HIV-positive patients suggests that this method has a place in routine diagnosis of pulmonary TB in countries with a high prevalence of HIV.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Anciano , Etiopía/epidemiología , Femenino , Seropositividad para VIH , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Sensibilidad y Especificidad , Hipoclorito de Sodio/análisis , Esputo/química , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/epidemiologíaRESUMEN
In a retrospective study at the Department for Infectious Diseases at Huddinge Hospital, 57 patients with extrapulmonary tuberculosis were identified from 1992 to 1997. Two categories of patients were found: young persons born abroad (the largest group) and elderly persons born in Sweden. Most patients showed a positive PPD, and the diagnosis was verified through bacteriological culture in 42/51 (82 per cent). Patients had sought help in a number of different clinical settings. Only four patients were shown to have resistant strains. This study demonstrates the difficulties inherent in the diagnostic process, with a long interval between appearance of symptoms to start of treatment: median 8 weeks but with a wide range. For one quarter of the patients, data sufficient to warrant conclusions regarding completed treatments are lacking. Efforts to increase knowledge on the part of medical personnel, compliance on the part of patients, and improvements in follow-up are essential in order to halt the spread of tuberculosis, to reduce morbidity and to prevent the development of resistance.
Asunto(s)
Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis , Adulto , Anciano , Antituberculosos/administración & dosificación , Antituberculosos/efectos adversos , Competencia Clínica , Resistencia a Múltiples Medicamentos , Emigración e Inmigración , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Refugiados , Estudios Retrospectivos , Suecia/epidemiología , Suecia/etnología , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/patología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/patologíaRESUMEN
A seroepidemiological study of human immune deficiency virus type 1 (HIV-1) and HIV-2/human T-lymphotropic virus type IV (HIV-2/HTLV-IV) infections was performed in Angola in October 1986. Until then five cases of acquired immune deficiency syndrome (AIDS) had been registered in Angola. During this study, another three cases with clinical AIDS were found and confirmed by HIV-1 serology. A total of 1,215 sera from groups of healthy persons and patients were tested for HIV-1 and HIV-2/HTLV-IV antibodies by enzyme-linked immunosorbent assays (ELISA). Sera positive by ELISA were also tested by Western blot (WB) analysis. In Luanda, the capital, HIV-1 antibodies were demonstrated in 0.4% (2/452) of male blood donors, in 0.3% (1/357) of pregnant women, in 1% (1/100) of tuberculosis patients, in 4% (4/94) of patients at medical wards, and in none of 22 women hospitalized with pelvic infections. In the Cabinda province, 11% (4/38) of postnatal women at a maternity ward were found to be HIV-1 seropositive, but only 2% (1/55) of other hospitalized patients and none of 32 male blood donors or 59 healthy persons in a village on the border to Zaire. Specific antibodies to HIV-2/HTLV-IV were not found in any of the sera. However, 16 out of 17 HIV-1 positive sera cross-reacted with HIV-2/HTLV-IV core proteins by WB. In October 1987, 280 of the blood donors from Luanda were retested for HIV-1 antibodies and one of them was found to have seroconverted during the previous year.(ABSTRACT TRUNCATED AT 250 WORDS)