Tuberculosis-associated severe CD4+T-lymphocytopenia in HIV-seronegative patients from Dakar

Objectives: To determine the Frequency and associated features of severe CD 4 + T-lymphocytopenia ( < 300 cells/mm(3)) in HIV-seronegative patients wit h tuberculosis, Methods: Statistical analysis of 430 consecutively enrolled HIV-seronegativ e inpatients with tuberculosis in two teaching hospitals in Dakar, Senegal, Results: The mean CD4+ cell count was 602 +/- 318.3 cells/mm(3). CD4+ cell counts were below 300 cells/mm3 in 62 patients (14.4%), Patients with fewer than 300 CD4+ cells/mm3 differed from those with higher counts in being Le ss likely to have a positive smear for acid-fast bacilli; in having a highe r frequency of extrapulmonary involvement (pleural effusion, adenopathy and miliary disease) and oral candidiasis; and in having smaller tuberculin re actions, lower haemoglobin levels, less cavitation and less patchy infiltra tion. After adjustment for gender and age, all differences remained except miliary disease. Conclusions: A substantial percentage (14.4%) of HIV-seronegative hospitali zed patients for tuberculosis in a West African country presented with seve re CD4+T-lymphocyte depletion and had clinical and radiographic features in dicative of more advanced disease and accompanying immunodepression, These results and those already published suggest that tuberculosis should be reg arded as one of the diseases associated with a subgroup of patients with "i diopathic CD4+ T-lymphocytopenia". (C) 2000 The British Infection Society.