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The Role of Bronchoscopy in the Diagnosis of Pulmonary Tuberculosis in Patients at Risk for HIV Infection
Section snippets
MATERIALS AND METHODS
Criteria for inclusion in the study were as follows: (1) Mycobacterium tuberculosis (MTb) or MAC was isolated from a specimen of sputum, BAL fluid, or TBB; (2) diagnosis of AIDS or HIV infection was established, or the patient was a member of a group at risk for HIV infection; (3) a diagnostic bronchoscopy, which included both BAL and TBB, was performed; (4) when obtained prior to bronchoscopy, sputum stain was negative for AFB.
The medical records of patients hospitalized between April 1984 and
RESULTS
All 31 patients with MTb infection were male; mean age was 38.3 years (range, 25 to 56 years). Risk factor for HIV infection was intravenous drug use in 24 patients, homosexuality in six, and blood transfusion in one. HIV infection was established by serologic tests in 18 patients who consented to testing. An additional three patients, who were not tested, met Centers for Disease Control (CDC) criteria for AIDS. In total, 12 patients met the CDC criteria for AIDS. The diagnosis of AIDS preceded
DISCUSSION
The diagnosis of tuberculosis is often unsuspected in HIV-infected patients. Symptoms are nonspecific, upper lobe cavitary infiltrates are usually not present, and the PPD skin test is often nonreactive.4 A previous study from our institution found that 5 (31 percent) of 16 HIV-infected patients with positive sputum cultures had AFB seen on smear.2 A more recent study found 19 (83 percent) of 23 patients with HIV infection and pulmonary tuberculosis had positive sputum smears.3 The role of FOB
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Manuscript received April 25; revision accepted July 3.