Tb co-infection with HIV/AIDS: A unique radiological presentation at Lacor Hospital - A postconflict Northern Uganda

Abstract

Background: Tuberculosis infection is thought as having the capacity to develop at any stage of HIV/AIDS infection. Pulmonary tuberculosis and extra-pulmonary tuberculosis are major complications in HIV/AIDS. Tuberculosis is still a diagnostic dilemma in low resource countries, with approximately 68.4% of all active pulmonary TB cases being negative for AAFBs on sputum. Additionally, it is reported that 46.7% of the active cases have disseminated TB with extra-pulmonary TB; further complicating the diagnosis in low resource communities. We therefore sought to clinically, histologically and radiologically characterize the various TB diagnosed in HIV/AIDS patients in Northern Uganda. Materials and Methods: A prospective cohort study was conducted on 320 sero-positive patients at Lacor Hospital. Clinical, histological, radiographic and ultra-sonographic features of confirmed HIV sero-positive patients with suspected TB co-infection were assessed. Patients were recruited consecutively and Chest, thoraco-lumbar and lumbar spine radiographs were taken and analyzed. Trans-thoracic ultrasonography for justified cases with pleural and pericardial effusion was conducted. FNAB and Tru-cut biopsies were performed for histological confirmation. Cases were followed-up for clinical outcomes within 2 months. Ethical review committee of Gulu University approved the study. Results: Atypical PTB chest x-ray findings: reticulo-nodular infiltrates 223(69.7%); hilar and mediastinal adenopathy 128(40%); pleural effusion 88(27.5%) and miliary 66(20.6%). Typical PTB chest x-ray findings: Apical reticulo-nodularities and fibro-cavitations 88(27.5%) and normal Chest x-ray 7(2.2%). Abdominal Ultrasound findings: porta-hepatis, para-aortic and splenic hilum lymphadenopathy 51(15.9%); Ascitis 26(8.1%); TB splenitis 17(5.3%) and TB nephritis with peri-renal abscess 1(0.3%). PTB was observed in 171(53.4%); disseminated TB in 135(42.2%) and EPTB in 14(4.4%). The majority 262(81.9%) of the patients improved and was discharged on DOTS while 58(18.1%) died. Conclusion: Imaging assessment is an important modality in TB/HIV/AIDS co-epidemic diagnosis. It is useful in making early diagnosis and prompt management of TB/HIV/AIDS co-infection.