Hepatic tuberculosis in human immunodeficiency virus co-infected adults: a case series of South African adults

BMC Infectious Diseases

Research Article

Paul K. Drain¹  Lilishia Gounder²  Mahomed-Yunus S. Moosa³  Pravikrishnen Moodley⁴  Andrew J. Hickey⁵ 

[1] Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA;Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA;Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa;Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, 4058, Durban, Mayville, South Africa;Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa;King Edward VIII Hospital, Durban, South Africa;Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, 4058, Durban, Mayville, South Africa;University of Maryland School of Medicine, Baltimore, USA;

关键词: HIV;    TB;    Liver;    Granuloma;    South Africa;   

DOI  :  10.1186/s12879-017-2222-2

 received in 2016-08-09, accepted in 2017-01-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAlthough Mycobacterium tuberculosis (TB) infection may cause extrapulmonary disease in HIV-infected adults, HIV-associated hepatic TB has been poorly characterized. Our objective was to describe hepatic TB in HIV-infected adults.MethodsRetrospective study of patients diagnosed with hepatic TB from 2005–2012 at Infectious Diseases Clinic, King Edward VIII Hospital, Durban, South Africa.ResultsAmong twenty cases of histology-confirmed HIV-associated hepatic TB, median CD4 count was 47 cells/μl (inter-quartile range 27–107 cells/μl) and 75% (15/20) of patients had pre-existing pulmonary TB. The most frequent clinical finding was hepatomegaly (85%). Liver enzyme abnormalities included elevated alkaline phosphatase (median 456 u/L, inter-quartile range 322–1,043 u/L) and gamma-glutamyltransferase (median 422 u/L, inter-quartile range 235–736 u/L). Acid-fast bacilli were cultured from liver tissue in 30% (6/20) of patients; 25% (5/20) identified as TB. With standard anti-TB therapy, liver enzymes improved within six months in 92% (11/12) of patients. One year after diagnosis, twelve patients resolved clinically, two patients developed drug-resistant TB and six patients died.ConclusionIn our case series of HIV-infected patients, hepatic TB occurred in patients with severe immunosuppression, who presented with hepatomegaly and abnormal liver enzymes. More than half of patients had resolution of liver function by six months however the 12-month mortality remained high.

【 授权许可】

CC BY   
© The Author(s). 2017