Manifestaciones clínico radiológicas en pacientes con coinfección tuberculosis pulmonar y VIH/sida / Clinical-radiologic manifestations inpatients with pulmonary tuberculosis and HIV/AIDS coinfection

Introducción: la infección por Mycobacterium tuberculosis es considerada la coinfección más común en personas VIH positivas. Objetivo: describir las principales características según variables sociodemográficas y clínicas seleccionadas de los pacientes VIH/sida con Tb pulmonar e identificar los hallazgos radiológicos más frecuentes para contribuir a un diagnóstico más temprano y disminuir la mortalidad por esta coinfección. Métodos: se realizó un estudio de casos clínicos. Se incluyeron 120 pacientes con VIH/sida y cultivo de esputo positivo de Mycobacterium tuberculosis, atendidos en el Hospital del Instituto de Medicina Tropical Pedro Kourí, en el periodo comprendido entre enero de 2004 y diciembre del 2010. Resultados: de los casos estudiados el 92,5 por ciento eran masculinos; 48,3 por ciento con color de piel blanca, la media de edad fue 35,6 años. La tuberculosis fue definitoria de sida en el 25,8 por ciento de los casos. La media del conteo de linfocitos T CD4+ fue 193,91 cel/µL. Las manifestaciones clínicas más frecuentes fueron fiebre, tos y pérdida de peso. Predominó el patrón radiológico primario, con infiltrados en lóbulos inferiores, infiltrados con derrame pleural e infiltrados extensos. El 25 por ciento tenían Rx de tórax normales. Conclusiones: la coinfección se presentó independientemente de los niveles de linfocitos T CD4. Las radiografías de tórax sin alteraciones no excluyeron el diagnóstico de tuberculosis en pacientes VIH/sida(AU)

Introduction: Mycobacterium tuberculosis infection is considered the most common coinfection in HIV-positive people. Objective: To describe the main characteristics according to the sociodemographic and clinical variables chosen from HIV/AIDS patients with pulmonary tuberculosis and to identify the most frequent radiological findings, in order to contribute to an earlier diagnosis and to reduce the mortality due to this coinfection. Methods: A clinical case study was carried out. A total of 120 patients with HIV/AIDS and sputum culture positive for Mycobacterium tuberculosis, treated at the Hospital of Pedro Kourí Institute of Tropical Medicine (IPK), and who were admitted between January 2004 and December 2010. Results: Out of the cases studied, 92.5 percent were male, 48.3 percent had white skin, and their mean age was 35.6 years. Tuberculosis was a defining condition for AIDS in 25.8 percent of the cases. The mean CD4+ T-lymphocyte count was 193.91 cells/?L. The most frequent clinical manifestations were fever, cough and weight loss. There was a predominance of the primary radiological pattern, with infiltrates in the lower lobes, infiltrates with pleural effusion, and extensive infiltrates. 25 percent percent had normal chest X-rays. Conclusions: Coinfection occurred independently of CD4+ T-lymphocyte levels. Unchanged chest radiographs did not exclude the diagnosis of tuberculosis in HIV/AIDS patients(AU)

Manifestaciones clínico radiológicas en pacientes con coinfección tuberculosis pulmonar y VIH/sida / Clinical-radiologic manifestations inpatients with pulmonary tuberculosis and HIV/AIDS coinfection

Introducción: la infección por Mycobacterium tuberculosis es considerada la coinfección más común en personas VIH positivas. Objetivo: describir las principales características según variables sociodemográficas y clínicas seleccionadas de los pacientes VIH/sida con Tb pulmonar e identificar los hallazgos radiológicos más frecuentes para contribuir a un diagnóstico más temprano y disminuir la mortalidad por esta coinfección. Métodos: se realizó un estudio de casos clínicos. Se incluyeron 120 pacientes con VIH/sida y cultivo de esputo positivo de Mycobacterium tuberculosis, atendidos en el Hospital del Instituto de Medicina Tropical Pedro Kourí, en el periodo comprendido entre enero de 2004 y diciembre del 2010. Resultados: de los casos estudiados el 92,5 por ciento eran masculinos; 48,3 por ciento con color de piel blanca, la media de edad fue 35,6 años. La tuberculosis fue definitoria de sida en el 25,8 por ciento de los casos. La media del conteo de linfocitos T CD4+ fue 193,91 cel/µL. Las manifestaciones clínicas más frecuentes fueron fiebre, tos y pérdida de peso. Predominó el patrón radiológico primario, con infiltrados en lóbulos inferiores, infiltrados con derrame pleural e infiltrados extensos. El 25 por ciento tenían Rx de tórax normales. Conclusiones: la coinfección se presentó independientemente de los niveles de linfocitos T CD4. Las radiografías de tórax sin alteraciones no excluyeron el diagnóstico de tuberculosis en pacientes VIH/sida(AU)

Introduction: Mycobacterium tuberculosis infection is considered the most common coinfection in HIV-positive people. Objective: To describe the main characteristics according to the sociodemographic and clinical variables chosen from HIV/AIDS patients with pulmonary tuberculosis and to identify the most frequent radiological findings, in order to contribute to an earlier diagnosis and to reduce the mortality due to this coinfection. Methods: A clinical case study was carried out. A total of 120 patients with HIV/AIDS and sputum culture positive for Mycobacterium tuberculosis, treated at the Hospital of Pedro Kourí Institute of Tropical Medicine (IPK), and who were admitted between January 2004 and December 2010. Results: Out of the cases studied, 92.5 percent were male, 48.3 percent had white skin, and their mean age was 35.6 years. Tuberculosis was a defining condition for AIDS in 25.8 percent of the cases. The mean CD4+ T-lymphocyte count was 193.91 cells/?L. The most frequent clinical manifestations were fever, cough and weight loss. There was a predominance of the primary radiological pattern, with infiltrates in the lower lobes, infiltrates with pleural effusion, and extensive infiltrates. 25 percent percent had normal chest X-rays. Conclusions: Coinfection occurred independently of CD4+ T-lymphocyte levels. Unchanged chest radiographs did not exclude the diagnosis of tuberculosis in HIV/AIDS patients(AU)

[Modern methods of diagnosis and control of the effectiveness of treatment for newly diagnosed fibro-cavernous pulmonary tuberculosis caused by mycobacteria with multiple drug resistance].

The clinical observation of the successful treatment of newly diagnosed fibro-cavernous pulmonary tuberculosis caused by mycobacteria of multidrug-resistant tuberculosis and the results of control of the effectiveness of treatment with modern high-tech radiation methods are presented. The necessity of an individual approach to the treatment of tuberculosis in this category of patients is shown.

Aspects radiologiques de la tuberculose pulmonaire chez les patients infectés par le VIH hospitalisés au service des maladies infectieuses et tropicales de Fann de Dakar, Sénégal

Objectifs : Déterminer la prévalence de la tuberculose pulmonaire chez les personnes vivant avec le VIH et décrire ses aspects radiologiques. Patients et méthodes : Il s'agit d'une étude rétrospective et descriptive réalisée à partir de dossiers de patients infectés par le VIH/Sida et hospitalisés au service des maladies infectieuses et tropicales pour une tuberculose pulmonaire durant la période allant du 1er janvier 2011 au 31 décembre 2013. Résultats : Durant cette période d'étude, nous avons colligé 124 cas de co-infections tuberculose pulmonaire/VIH sur un total de 571 cas de tuberculose toutes formes confondues soit une prévalence de 21,7%. Le sexe masculin était prédominant avec un sex-ratio de 1,48. La notion de contage tuberculeux était retrouvée dans 8,9% des cas. Les signes cliniques classiques de la tuberculose pulmonaire ont été retrouvés notamment l'altération de l'état général (105 cas), la toux chronique (93 cas) et la fièvre chez (105 cas). L'intradermoréaction à la tuberculine était positive dans 7,3% des cas. Les crachats BAAR étaient réalisés dans 73,3% des cas et positifs dans 18,5% des cas. Le GeneXpert était réalisé chez 62 patients et positif dans 9,7% des cas. La radiographie thoracique était normale chez 35 patients et dans les autres cas les lésions radiologiques étaient dominées par : les infiltrats (20 cas); les miliaires (17 cas), infiltrat + opacités réticulo-nodulaires (15 cas), caverne + infiltrats (14 cas), opacités réticulo-nodulaires (13 cas). Dans la plupart des cas (63,7%), la localisation des lésions était diffuse. Conclusion : Les aspects radiologiques habituels de la tuberculose pulmonaire sont modifiés chez les patients infectés par le VIH avec atteintes parenchymateuses plus étendues

[Patients with tuberculosis associated with chronic non-specific lung diseases].

159 patients have been observed to assess the efficiency of laseropuncture use in a complex treatment of patients with lung tuberculosis and chronic bronchitis. Disbalance in renal meridian (R), urinary bladder (V) and insufficiency of the energy in colon meridian (60.3%) were observed in patients with tuberculosis associated with chronic bronchitis. Medium deviations of electro-skin conductivity from the physiological gape in meridians of GI, IG, F, V, R in patients with tuberculosis associated with chronic bronchitis considerably differ from those data obtained from patients with only tuberculosis. Obtained data testify more severe disorders of energy balance in meridians of patients having except tuberculosis other associated diseases. Medium parameters of deviations from the physiological gape considerably decrease after the course of laseropuncture compared with those patients treated traditionally. Improve of the course of the chronic bronchitis was noted in patients who underwent laseropuncture.

[Endocavitary ultraviolet laser irradiation in the preoperative preparation of patients with progressive fibrocavernous tuberculosis].

The authors have improved a procedure for preoperatively preparing patients with progressive drug-resistant fibrocavernous tuberculosis. This has been achieved by using ultraviolet laser irradiation (wavelength 248 nm) of the cavity walls in the multimodality treatment of this disease. Endocavitary laser irradiation increases preoperative preparation and surgical treatment and reduces the number of postoperative complications.

Low level laser therapy for treating tuberculosis.

BACKGROUND: The main treatment for tuberculosis is antituberculous drugs. Low level laser therapy is used as an adjunct to antituberculous drugs, predominantly in the former Soviet Union and India. OBJECTIVES: To compare low level laser therapy plus antituberculous drugs with antituberculous drugs alone for treating tuberculosis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (December 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to December 2005), EMBASE (1974 to December 2005), CINAHL (1982 to December 2005), Science Citation Index (1945 to December 2005), PEDro (1929 to December 2005), the Central Medical Library of Moscow catalogue (1988 to June 2005), the internet, and reference lists of articles. We contacted relevant organizations and researchers for the original version. SELECTION CRITERIA: Randomized trials comparing low level laser therapy plus antituberculous drugs with antituberculous drugs alone in people with tuberculosis. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data, including adverse events. MAIN RESULTS: One randomized controlled trial (130 participants) conducted in India met the inclusion criteria. This trial was poorly reported, with no information on the generation of allocation sequence or allocation concealment. The trial report did not provide details on the group that each of the participants were randomized into or which group those participants that left the trial were from. This precluded the use of its data on time to sputum conversion and other outcome measures for analysis. AUTHORS' CONCLUSIONS: The use of low level laser therapy for treating tuberculosis is still not supported by reliable evidence. Researchers need to focus on conducting well-designed randomized controlled trials to justify the continued participation of volunteers for studies of this experimental intervention.

Role of gallium arsenide laser irradiation at 890 nm as an adjunctive to anti-tuberculosis drugs in the treatment of pulmonary tuberculosis.

BACKGROUND: Tuberculosis is a global emergency with about nine million people developing disease every year. The long duration of treatment has emerged as a major obstacle in the control of tuberculosis. There is a need for development of new drugs and or shortened therapy. METHODS: The present study was carried out to explore whether any benefit could be achieved by the addition of low level energy laser therapy (LLLT) to the conventional anti-tubercular chemotherapy. One-hundred-thirty new sputum smear positive patients of pulmonary tuberculosis were enrolled to evaluate the bio-stimulatory effects of Gallium Arsenide laser irradiation at 890 nm, as an adjuvant therapy. These patients were randomly divided into two groups to receive either LLLT or sham irradiation (control) concomitantly with anti-tuberculosis chemotherpy. RESULTS: The patients treated with semiconductor laser as an adjuvant therapy along with anti-tuberculosis drugs had a faster clearance of tubercle bacilli from the sputum as compared to the control group (P value at :45 days=0.1392, 60 days=0.0117, 75 days=0.00805, 90 days=0.00739). CONCLUSIONS: These findings provide preliminary evidence that low level laser therapy with Gallium Arsenide laser may be a promising adjunctive therapy for patients with tuberculosis. Faster conversion of sputum should prevent the development of resistant mutants.

[Efficiency of supra-venous blood laser radiation used in the treatment of disseminated pulmonary tuberculosis in adolescents]. / Effektivnost' ispol'zovaniia nadvennogo lazernogo oblucheniia krovi v lechenii rasprostranennogo tuberkuleza legkikh u podrostkov.

In 19 of 40 adolescent patients with disseminated pulmonary tuberculosis, supravenous blood laser radiation was used in the complex treatment 2-3 weeks after the initiation of chemotherapy. The use of this type of laser therapy enhanced the efficiency of the treatment, accelerated positive changes of tuberculosis by 2.5-3.5 months, as evidenced by clinical and laboratory parameters, led to a smooth course of tuberculosis to develop less pronounced residual changes in the lung.

Low level laser therapy for treating tuberculosis.

BACKGROUND: The main treatment for tuberculosis is antituberculous drugs. Low energy laser therapy is used as an adjunct to antituberculous drugs, predominantly in the former Soviet Union and India. OBJECTIVES: To assess the benefits and harms of low level laser therapy for treating tuberculosis in randomized and quasi-randomized controlled trials. To seek information about potential benefits or harms from observational studies. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group specialized trials register (up to June 2001), the Cochrane Controlled Trials Register (Issue 1, 2001), MEDLINE (1966 to December 2001), EMBASE (1988 to December 2001), CINAHL (up to November 2001), PEDro (up to November 2001), the Science Citation Index (up to December 2001), National Centre for Science Information at the Indian Institute of Science (15 April 2002), electronic catalogue of the Central Medical Library (Moscow; 1988 to January 2002), the internet using 'Google' (21 January 2002), and reference lists of articles. We contacted relevant organizations and researchers. SELECTION CRITERIA: (1) Randomized and quasi-randomized controlled trials comparing low level laser therapy with no low level laser therapy in people with tuberculosis. We also conducted a subsidiary analysis of of the potential benefits and harms from observational studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse event information was collected from the studies. MAIN RESULTS: No randomized or quasi-randomized controlled trials met the inclusion criteria for the review. The potential benefits and harms from 29 observational studies involving over 3500 people are described. REVIEWER'S CONCLUSIONS: We have not identified any well designed trials using low level laser therapy (LLLT) to treat tuberculosis. Therefore, the use of LLLT to treat tuberculosis is not supported by reliable evidence.

[Clinical efficacy and roentgen results of laser therapy in combined treatment of patients with newly diagnosed pulmonary tuberculosis]. / Kliniko-renthenolohichna efektyvnist' zastosuvannia laseropunktury v kompleksnomu likuvanni khvorykh z vpershe vyiavlenym tuberkul'ozom lehen'.

Efficiency was studied of use of laseropuncture in a complex treatment of 80 patients with pulmonary tuberculosis first diagnosed. The results of studies made showed that use of laseropuncture in the treatment complex promote significantly the dissipation of the intoxicatory and bronchopulmonary syndromes, the bacteria no longer recovered, the time of closure of the cavities of decomposition getting shortened, the indices for the function of external breathing improved.

[Very high frequency electromagnetic irradiation in multimodal treatment of patients with disseminated infiltrative pulmonary tuberculosis]. / Elektromagnitnoe izluchenie kraine vysokoi chastoty v kompleksnom lechenii bol'nykh rasprostranennym infil'trativnym tuberkulezom legkikh.

Multimodality treatment involving very high-frequency electromagnetic radiation (VHFER) in combination with the antioxidants alpha-tocopherol and sodium thiosulfate, which had been performed in 27 patients with disseminated infiltrative pulmonary tuberculosis, was effective. As compared to patients receiving chemotherapy in combination with electromagnetic radiation (n = 29) and routine chemotherapy alone (n = 29), these patients had more benefits from the multimodality treatment in terms of bacterial isolation cessation and reduced hospital stay by 1.5-2 months, minimal pneumofibrotic changes occurred in 63% of the patients. Combined VHFER and antioxidative therapy were found to exert a normalizing effect on lipid peroxidation and immunity.

[Several possibilities of organizing multimodal treatment of patients with pulmonary tuberculosis]. / Nekotorye vozmozhnosti optimizatsii kompleksnogo lecheniia bol'nykh tuberkulezom legkikh.

The paper analyzes the outcomes of treatment and some laboratory findings, and external respiratory function in 46 patients with destructive pulmonary tuberculosis who were treated with drugs and chest cm-range microwave radiation in an experimental group of patients receiving isoniazid lymphotropically versus a control group taking only chemotherapy. The experimental group patients showed accelerated cessation of bacterial isolation, infiltration resolution, and less residual lung changes. They also exhibited better values of external respiratory function. The serum levels of medium-weight molecules and circulating immune complexes became normal more rapidly. The immunological indices improved slowly.

[Intravenous laser radiation treatment of acute and progressive forms of tuberculosis in teenagers]. / Lechenie ostrykh i progressiruiushchikh form tuberkuleza u podrostkov s ispol'zovaniem vnutrivennogo lazernogo oblucheniia.

In 25 of 44 teenagers suffering from acute and progressive tuberculosis, intravenous blood laser radiation was included into its multimodality treatment following 2-4 weeks of the initiation of chemotherapy. The use of laser enhanced the efficiency of treatment, accelerated positive changes by 1.5-2 months by major clinical and laboratory indices, made the disease run smoothly and caused less pronounced residual changes in the lung.

[Impact of combined magnetic and laser radiation of regional pulmonary blood flow in patients with destructive pulmonary tuberculosis]. / Vliianie sochetannogo magnitolazernogo oblucheniia na sostoianie zonal'nogo legochnogo krovotoka u bol'nykh destruktivnym tuberkulezom legkikh.

Rheopulmonography was used to study regional pulmonary blood flow in 30 patients with destructive pulmonary tuberculosis before and after combined magnetic and laser radiation (an experimental group) and in 28 patients receiving the routine chemotherapy (a control group). The use of combined exposure of a constant magnetic field and laser radiation was found to promote pulmonary vascular tone, better microcirculatory blood flow, and increased pulse blood filling in the affected portion of the lung.

[Effects of low-intensity laser irradiation on hormonal responsiveness of patients with pulmonary tuberculosis]. / Vliianie nizkointensivnogo lazernogo izlucheniia na gormonal'nuiu reaktivnost' bol'nykh tuberkulezom legkikh.

To examine the impact of low-intensive laser radiation (LILR) on endocrine function in patients with pulmonary tuberculosis, the time course of blood levels of thyroid hormones, cortisol, and insulin was studied in 117 patients of whom 64 received complex treatment by using LILR. Pulmonary tuberculosis was ascertained to be characterized by a marked hormonal imbalance, including impaired metabolism of thyroid hormones, hypercorticism, altered pancreatic incretion, which negatively affects the efficiency of antituberculosis therapy. Intravenous and epicutaneous therapy promotes recovery of endocrine responsiveness and enhances the efficiency of treatment in patients with pulmonary tuberculosis.