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Publications (6)7.13 Total impact

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    ABSTRACT: The medical wards of a referral hospital in Dar es Salaam, Tanzania. To investigate the impact of HIV infection on clinical features in tuberculous lymphadenitis. A prospective clinical study of HIV seropositive and HIV seronegative patients with lymphadenopathy. Of 128 patients with peripheral lymphadenopathy, 24 had no tuberculosis (TB) and in 10 patients TB was found only in other organs. The remaining 94 patients, of whom 76% were HIV seropositive, formed our study population. TB lymphadenitis was considered proven in 89 and probable in 5 patients. Disseminated TB (both TB adenitis and TB in other organs) was diagnosed more often in HIV seropositive than in HIV seronegative patients (52% versus 26%, P < 0.03). 59% of the 71 HIV-infected patients compared to only 4% of the 23 patients without HIV infection were over 30 years of age (P < 0.02). The following clinical features were significantly associated with HIV infection: dyspnoea, respiratory rate > 20/min, low motility score (bedridden), neurological abnormalities, hepatomegaly, splenomegaly, lymph node size < 2.5 cm, negative PPD skin test, lymphopenia (< 1000/cm3) and presence of pleural fluid. Co-infection with HIV influences several clinical and laboratory features in patients with tuberculous lymphadenitis.
    Tubercle and Lung Disease 10/1995; 76(5):401-6.
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    ABSTRACT: Setting: The medical wards of a referral hospital in Dar es Salaam, Tanzania. Objective: To investigate the impact of HIV infection on clinical features in tuberculous lymphadenitis. Design: A prospective clinical study of HIV seropositive and HIV seronegative patients with lymphadenopathy. Results: Of 128 patients with peripheral lymphadenopathy, 24 had no tuberculosis (TB) and in 10 patients TB was found only in other organs. The remaining 94 patients, of whom 76% were HIV seropositive, formed our study population. TB lymphadenitis was considered proven in 89 and probable in 5 patients. Disseminated TB (both TB adenitis and TB in other organs) was diagnosed more often in HIV seropositive than in HIV seronegative patients (52% versus 26%, P < 0.03). 59% of the 71 HIV-infected patients compared to only 4% of the 23 patients without HIV infection were over 30 years of age (P < 0.02). The following clinical features were significantly associated with HIV infection: dyspnoea, respiratory rate > 20/min, low motility score (bedridden), neurological abnormalities, hepatomegaly, splenomegaly, lymph node size < 2.5 cm, negative PPD skin test, lymphopenia (< 1000/cm(3)) and presence of pleural fluid. Conclusion: Co-infection with HIV influences several clinical and laboratory features in patients with tuberculous lymphadenitis.
    Tubercle and Lung Disease 10/1995; 76(5-76):401-406. DOI:10.1016/0962-8479(95)90005-5
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    ABSTRACT: In a prospective study, we investigated whether human immunodeficiency virus (HIV) infection alters the clinical presentation in patients with tuberculous pleuritis. One hundred twelve of 118 patients who presented with pleural effusion suffered from tuberculosis (TB); 65 patients (58%) were HIV seropositive. Evidence of disseminated TB was found more often in HIV-positive than in HIV-negative patients (30.8% vs 10.6%, p < 0.02). Dyspnea, fever, night sweat, fatigue, and diarrhea, severe tachypnea, hepatomegaly, splenomegaly, and lymphadenopathy were significantly more common in HIV-infected than in HIV-negative patients with TB. The same applied to a negative Mantoux reaction, lower hemoglobin, higher beta 2-microglobulin values, and in pleural fluid, lower albumin and higher gamma-globulin levels. Among HIV-infected patients, PPD skin test anergy was significantly associated with relative low albumin and gamma-globulin levels of pleural fluid. However, the radiographic features did not differ with respect to HIV status; they were predominantly those of primary pleuritis (78% in each group). We conclude that coexisting HIV infection affects clinical and laboratory features, but not the radiographic presentation of patients with TB pleuritis in Tanzania.
    Chest 11/1994; 106(5):1471-5. DOI:10.1378/chest.106.5.1471 · 7.13 Impact Factor
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    ABSTRACT: The AIDS epidemic has been associated with an increase in the incidence of tuberculosis, pulmonary or extrapulmonary. To compare morphological changes in tuberculous pleurisy, and response to therapy in HIV-positive and-negative patients. 57 consecutive patients admitted between January and August 1991 with tuberculous pleurisy who were biopsy proven were studied. 36 were HIV-positive and 21 were HIV-negative. 3 types of morphological changes were observed: reactive, hyporeactive and non-reactive. Hypo- and non-reactive patterns were found in 14 of 36 HIV-positive patients but in only 2 of 21 HIV-negative patients (P < 0.02). In the HIV-positive group, 10 of the 14 with hypo- or non-reactive patterns had other HIV-related complications, compared to 6 of 22 with reactive patterns (P < 0.01). When HIV-positive patients' response to therapy was investigated, 2 of 5 patients with hypo- and non-reactive patterns improved compared to all 13 with reactive patterns (P < 0.05). A hypo- or non-reactive tissue reaction in HIV-positive patients with tuberculous pleuritis seems to indicate a less favourable prognosis.
    Tubercle and Lung Disease 07/1994; 75(3):195-8. DOI:10.1016/0962-8479(94)90007-8
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    ABSTRACT: In order to evaluate procedures leading to the diagnosis of tuberculous lymphadenitis, a prospective clinical study was carried out of patients with lymphadenopathy admitted to the medical wards of a referral hospital in Tanzania. The yield of diagnostic procedures (direct auramine/Ziehl-Neelsen (ZN) stained smears, Löwenstein-Jensen (LJ) cultures, cytology and histological examinations of fine needle aspirations (FNA) and biopsy material of lymph nodes, respectively, was compared. We also tried to identify clinical diagnostic markers. One hundred and twenty-eight (99 HIV-seropositive) patients were included. In 89 (67 HIV-positive) patients TB lymphadenitis could be proven. Histology and LJ culture of a lymph node biopsy had the highest diagnostic yield, 85% and 88% respectively, followed by detection of acid-fast bacilli (AFB) in biopsy smear (53%) and in fine-needle aspirations (35%). The diagnostic yield of the several procedures was not affected by associated HIV infection. Macroscopic caseation was 100% predictive for TB with a sensitivity of 69%. Firm and matted lymph nodes, ESR > 100 mm/hr, a positive PPD skin test and pleural opacity on a chest x-ray proved to be independent predictors for TB. Retrospective testing of a stepwise diagnostic approach based on direct smears of FNA, macroscopic visible caseation and direct smear of biopsy tissue, suggests that in 93% of the patients a definite diagnosis of TB lymphadenitis could have been made. Our data suggest that in HIV/TB epidemic areas most of the cases of TB lymphadenitis can be diagnosed correctly by simple and cheap methods which are generally available at district hospitals. Our findings need further prospective validation, however.
    Tropical and geographical medicine 02/1994; 46(5):288-92.
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    ABSTRACT: In a prospective study of 118 patients with pleural effusion, tuberculosis (TB) was diagnosed in 112. In 84 patients the diagnosis of TB was made by detection of acid-fast bacilli by stain (auramine, Ziehl-Neelsen) or by culture of mycobacteria (Löwenstein-Jensen medium) in pleural fluid or pleural tissue (obtained by closed biopsy) or by the presence of caseating granulomas in histological sections. In 28 patients the diagnosis of TB was considered probable, based on good response to anti-tuberculous therapy. The highest diagnostic yield was obtained by histology (85%), followed by culture of pleural biopsy (37%) and pleural fluid culture (36%). Pulmonary tuberculosis was found in 8 patients and dissemination of TB to other sites in 25 patients of whom 20 were HIV positive. By logistic regression analysis we identified 2 independent diagnostic markers for TB pleuritis: pleural fluid protein > 50 g/l (Odds ratio 12.1, 95% confidence interval (CI): 1.1-128.3) and adenosine deaminase of > 10 U/l (Odds ratio 11.08, 95% CI: 1.3-96.4). We conclude that conventional facilities of a referral hospital are sufficient to diagnose tuberculous pleuritis as well as disseminated tuberculosis irrespective of HIV infection. However, for regions with overstretched health services and high prevalences of tuberculous pleurisy in patients with pleural effusion we suggest a simplified diagnostic approach based on exclusion of other causes of pleural effusion by simple means and use of these diagnostic markers.
    Tropical and geographical medicine 02/1994; 46(5):293-7.