CD4 T lymphocyte count and the radiographic presentation of pulmonary tuberculosis

A study of the relationship between these factors in patients with human immunodeficiency virus infection

Mark D Keiper, M. Beumont, A. Elshami, C. P. Langlotz, W. T. Miller

Research output: Contribution to journalArticle

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Abstract

Background: Pulmonary infection and tumor in the AIDS population has a variable clinical and radiographic presentation. The association between the radiographic presentation of pulmonary tuberculosis and CD4 T lymphocyte count in the HIV-infected patient is investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of infected subjects. Methods: A retrospective analysis of chest radiographs, CD4 T lymphocyte counts, and clinical history of 35 subjects from 3 urban hospitals was performed. All subjects were HIV-seropositive and had culture-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of either a pattern characteristic of post-primary tuberculosis (typical pattern) or a pattern uncharacteristic of post-primary infection (atypical pattern). Results: Twenty-one of 26 subjects with a CD4 T lymphocyte count less than 0.20 x 109 cells/L, whereas only 1 of 9 subjects with a CD4 T lymphocyte count of 0.20 x 109 cells/L or more presented with an atypical pattern of pulmonary tuberculosis (p<0.001). The mean CD4 T lymphocyte counts of those subjects presenting with atypical versus typical radiographic pattern of post-primary pulmonary tuberculosis were 0.069 x 109 cells/L (n=22) and 0.323 x 109 cells/L (n=13), respectively (p<0.01). Twenty-one of the 22 subjects with an atypical radiographic pattern of pulmonary tuberculosis were significantly immunosuppressed (CD4<0.20 x 109 cells/L). Atypical radiographic pattern included diffuse and lower lobar opacities, pleural effusion, mediastinal adenopathy, interstitial nodules, and a normal chest radiograph. Conclusion: AIDS patients presenting with CD4 count less than 0.20 x 109 cells/L and an atypical radiographic pattern for pulmonary tuberculosis are at risk for tuberculous infection requiring appropriate treatment and isolation until the diagnosis of pulmonary tuberculosis has been excluded.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
JournalChest
Volume107
Issue number1
StatePublished - Jan 1 1995

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Virus Diseases
CD4 Lymphocyte Count
Pulmonary Tuberculosis
HIV
T-Lymphocytes
Acquired Immunodeficiency Syndrome
Thorax
Infection
Urban Hospitals
Pleural Effusion
Early Diagnosis
Tuberculosis
Lung
Therapeutics
Population
Neoplasms

Keywords

  • AIDS
  • CD4 lymphocyte
  • HIV infection
  • chest radiograph
  • pulmonary tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

CD4 T lymphocyte count and the radiographic presentation of pulmonary tuberculosis : A study of the relationship between these factors in patients with human immunodeficiency virus infection. / Keiper, Mark D; Beumont, M.; Elshami, A.; Langlotz, C. P.; Miller, W. T.

In: Chest, Vol. 107, No. 1, 01.01.1995, p. 74-80.

Research output: Contribution to journalArticle

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abstract = "Background: Pulmonary infection and tumor in the AIDS population has a variable clinical and radiographic presentation. The association between the radiographic presentation of pulmonary tuberculosis and CD4 T lymphocyte count in the HIV-infected patient is investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of infected subjects. Methods: A retrospective analysis of chest radiographs, CD4 T lymphocyte counts, and clinical history of 35 subjects from 3 urban hospitals was performed. All subjects were HIV-seropositive and had culture-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of either a pattern characteristic of post-primary tuberculosis (typical pattern) or a pattern uncharacteristic of post-primary infection (atypical pattern). Results: Twenty-one of 26 subjects with a CD4 T lymphocyte count less than 0.20 x 109 cells/L, whereas only 1 of 9 subjects with a CD4 T lymphocyte count of 0.20 x 109 cells/L or more presented with an atypical pattern of pulmonary tuberculosis (p<0.001). The mean CD4 T lymphocyte counts of those subjects presenting with atypical versus typical radiographic pattern of post-primary pulmonary tuberculosis were 0.069 x 109 cells/L (n=22) and 0.323 x 109 cells/L (n=13), respectively (p<0.01). Twenty-one of the 22 subjects with an atypical radiographic pattern of pulmonary tuberculosis were significantly immunosuppressed (CD4<0.20 x 109 cells/L). Atypical radiographic pattern included diffuse and lower lobar opacities, pleural effusion, mediastinal adenopathy, interstitial nodules, and a normal chest radiograph. Conclusion: AIDS patients presenting with CD4 count less than 0.20 x 109 cells/L and an atypical radiographic pattern for pulmonary tuberculosis are at risk for tuberculous infection requiring appropriate treatment and isolation until the diagnosis of pulmonary tuberculosis has been excluded.",
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