The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

Case Report Ind. J. Tub., 1992, 39, 35
HIV INFECTION AND PULMONARY TUBERCULOSIS :
REPORT ON 6 CASES
V. Sivaraman 1 , Gilbert Fernandez 2 and R. Sambasiva Rao 3
(Original received on 16.4.91; Revised version received on 5.8.91; Accepted on 7.11.91)
Summary. During a 3 month period, 225 patients
with pu1monary tuberculosis admitted to TB
Sanatorium, Pondicherry were screened for HIV
infection. Six were found ELISA positive : all were
smearpositive for AFB. Their clinacal
presentation, investigation results and
management while in hospital are described.
Introduction
There is an increasing awareness of the
problem of acquired immunodeficiency syndrome
(AIDS) caused by the human immunodeficiency
retrovirus (HIV) in different parts of the world.
Observations on the association of
tuberculosis with HIV infection have been
published abroad. As far as we are aware no such
reports are available in the Indian literature.
Hence, the experience with 6 cases of co-existing
HIV infection and tuberculosis, in TB
Sanatorium, Pondicherry, would be of interest.
During the period 31.1.1990 to 31.4.1991, the
following types of admissions into the TB
Sanatorium, Pondicherry, were screened for
AIDS :
Patients with atypical radiographic pattern.
Patients harbouring multi-drug resistant
bacilli.
Patients with fairly limited radiological
lesions whose general condition showed
unexplained deterioration.
It would have been desirable to test all the
admissions but due to resources constraint a
selection had to be made.
Routine history, clinical examination, skiagram
of chest, sputum smear and culture examination
for AFB, urine, blood and stool examinations,
and liver function tests, whenever indicated, were
undertaken for all the selected cases.
For immunological examination, blood was
collected by venepuncture with aseptic
precautions. Serum was separated and stored at
20°C till needed. For the test, serum was diluted
1:100 and tested for anti-HIV antibodies by
ELISA technique as per the manufacturer's
instructions (Vironstika, Organon). In respect of
those found reactive by ELISA, the test was
repeated before it was considered positive. The
ELISA positive specimens were subjected to
Western Blot confirmatory test (HIV Reference
Centre, CMC, Vellore). The presence of
antibodies to antigen p24 was considered positive
in Western Blot test.
During the period in question. 225 patients
were so selected for testing of which six were
found positive and are reported hereunder :
Case Reports
Case 1
Mr. D., Hindu male aged 39 years, a textile
mill worker was admitted on 20.4.1990 for cough
with expectoration of 2 months, chest pain one
month, fever 3 days and blood stained sputum.
Skiagram of the chest showed a cavity with fluid
level in left upper zone suggestive of lung abscess
(Fig. 1). Sputum smear was repeatedly negative
for AFB. The patient was put on Ampicillin.
Flexible fiberoptic bronchoscopy did not reveal
any significant finding. Bronchoscopy secretions
1. Medical Superintendent; 2. Assistant Surgeon, TB Sanatorium, Gorimedu, Pondicherry; 3. Chief Investigator,
AIDS Surveillance Centre (ICMR), Department of Microbiology, JIPMER, Pondicherry..
Correspondence : Dr. V. Sivaraman, Medical Superintendent, TB Sanatorium, Gorimedu, Pondicherrv-605 006.