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Chapter 29 : Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People

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Abstract:

Tuberculosis among human immunodeficiency virus (HIV)-infected people has become an epidemic within an epidemic. Autopsy of HIV-positive tuberculosis patients frequently reveals old fibrous or calcified lesions of tuberculosis in the thorax that are adjacent to recent active lesions with bacilli. In 87% of cadavers, tuberculosis was disseminated to more than one organ, nearly always involving the lungs, liver, spleen, multiple internal lymph nodes, and bone marrow. The histologic patterns of tuberculosis reflect the integrity of the cellular immune response of the patient. Recent studies of HIV-infected individuals show that Th1 cells are progressively lost, shifting the ratio to a Th2-dominant population. Understanding the timing of Th1 function loss is key to understanding the altered host response in tuberculosis and to developing strategies for prophylaxis. Due to the high risk of developing tuberculosis by reactivation or reinfection, trials in Africa and elsewhere are under way to assess the value of antituberculosis prophylaxis in preventing or deferring the development of tuberculosis. The majority were diagnosed as having primary pulmonary or extrapulmonary tuberculosis. The radiographic appearances of advanced pulmonary tuberculosis with or without cavitation are well recognized. In our experience, HIV-associated miliary pulmonary tuberculosis is readily missed as a clinical diagnosis because the lesions are often too small to be visualized and sputum negativity is common.

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
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Figures

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Figure 1

Clinical and immunopathological courses of HIV-associated tuberculosis. The figure does not represent one patient but is a composite of cross-sectional data ( Table 1 ).

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
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Image of Figure 2
Figure 2

Miliary tuberculosis. Cut section of lung shows seeding of the parenchyma and peribronchial lymph nodes by small ("millet seed") nodules.

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
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Image of Figure 3
Figure 3

Spectrum of histological responses in HIV-associated tuberculosis patients. As HIV disease progresses, there is a loss of the normal cellular immune response (granulomatous reaction) and a concomitant increase in numbers of mycobacteria and in necrosis.

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
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Tables

Generic image for table
Table 1

Representative correlations of blood CD4 T-lymphocyte counts with clinicopathological presentation of tuberculosis

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
Generic image for table
Table 2

Distribution of tuberculosis lesions in HIV-positive patients at autopsy in Zaire and Côte d'Ivoire

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
Generic image for table
Table 3

Density of Langhans giant cells in tuberculosis lesions of HIV-positive cadavers in Abidjan correlated with premortem blood CD4T-lymphocyte counts

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29
Generic image for table
Table 4

Density of AFB in untreated tuberculosis lesions of HIV-positive cadavers in Abidjan correlated with premortem blood CD4T-lymphocyte counts

Citation: Lucas S, Nelson A. 1994. Pathogenesis of Tuberculosis in Human Immunodeficiency Virus-Infected People, p 503-513. In Bloom B (ed), Tuberculosis. ASM Press, Washington, DC. doi: 10.1128/9781555818357.ch29

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