T. Madebo et al., HIV-INFECTION AND MALNUTRITION CHANGE THE CLINICAL AND RADIOLOGICAL FEATURES OF PULMONARY TUBERCULOSIS, Scandinavian journal of infectious diseases, 29(4), 1997, pp. 355-359
Patients with HIV infection have atypical clinical features of pulmona
ry tuberculosis; however, our knowledge on how malnutrition affects th
e clinical presentation is limited. We studied the influence of malnut
rition and HIV infection on the clinical and radiological features of
pulmonary tuberculosis (TB), We studied 239 consecutive acid fast baci
llus-positive adult patients, Patients were investigated by clinical,
radiological, anthropometric and laboratory methods. 78% of the patien
ts were malnourished (BMI < 18.5) and 43% were severely malnourished (
BMI < 16). 20% were HIV-positive. HIV-positive TB had significantly mo
re oral candidiasis (OR = 3.72), diarrhoea (OR = 2.71), generalized ly
mphadenopathy (OR = 2.63), skin disorders (OR = 2.27), neuropsychiatri
c illness (OR = 2.44), hilar lymphadenopathy (OR = 2.07), but less cav
itation (OR = 0.64) and upper lung lobe involvement (OR = 0.70). HIV-n
egative and severe malnourished patients presented more often with dys
pnoea (OR=1.44), diarrhoea (OR=1.64), night sweat (OR=1.83), and less
with haemoptysis (OR=0,58) and cavitation (OR = 0.61), The size of Man
toux was associated with HIV infection and malnutrition. In a logistic
regression analysis both HIV status and malnutrition were associated
with atypical presentation of pulmonary tuberculosis. Malnutrition and
HIV infection both contribute for atypical presentation of pulmonary
tuberculosis. The risk of such atypical presentation is particularly h
igh among the severely malnourished HIV-infected patients.