Outcomes and complications of hospitalised patients with HIV-TB co-infection.

BACKGROUND: Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available. METHODS: Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015. RESULTS: Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%. CONCLUSIONS: Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.

CONTEXTE: La tuberculose (TB) est l'une des causes les plus courantes d'hospitalisation chez les patients VIH positifs. Malgré cela, les résultats hospitaliers des patients atteints de cette coinfection ont rarement été décrits depuis que le traitement antirétroviral est devenu largement disponible. MÉTHODES: Etude de cohorte prospective de patients adultes infectés par le VIH hospitalisés pour TB dans six hôpitaux de référence à Medellin, en Colombie, d'août 2014 à juillet 2015. RÉSULTATS: Sur 128 patients infectés par le VIH hospitalisés pour TB, l'âge moyen était de 38,4 ans; 79,7% étaient des hommes. Le VIH a été diagnostiqué à l'admission chez 28,9% des patients. Le nombre médian de lymphocytes T CD4+ était de 125 (±158 SD) cellules/µL. Seuls 47,3% des patients dont le diagnostic de VIH était connu lors de leur admission étaient sous traitement antirétroviral et 11,1% seulement avaient subi un test cutané à la tuberculine l'année précédente. Une toxicité médicamenteuse due aux médicaments antituberculeux est survenue chez 11,7% des patients. La durée moyenne de séjour était de 23,2 jours et 10,7% des patients ont été réadmis. La mortalité était de 5,5%. CONCLUSIONS: La mortalité hospitalière attribuable à la TB chez les patients VIH positifs est faible dans les hôpitaux de référence en Colombie. Les cas de TB chez les patients infectés par le VIH surviennent principalement chez les patients à un stade avancé du VIH, ou qui ne sont pas sous traitement antirétroviral, malgré un diagnostic connu de VIH. Seul un patient sur 10 de cette cohorte a subi un dépistage actif de la TB latente, ce qui reflète peut-être des opportunités de traitement manquées.

Neurologic alterations in an HIV adult patient with pertussis: a case report.

BACKGROUND: Pertussis is a highly contagious disease of public health interest caused by the bacterium Bordetella pertussis. Although its incidence has decreased substantially after the introduction of a vaccination, the burden of the disease remains high. Although the paroxysmal phase is highly disabling, complications are uncommon and more prevalent in children than in adults. The most frequent neurological complication is encephalopathy, but seizures, paresis, paraplegia, ataxias, aphasias, and decerebration postures have also been described. The complication of decerebration postures has not been previously reported in adults. CASE PRESENTATION: We present a video case of an adult HIV patient with severe coughing paroxysms, post-tussive emesis and syncope, whose workup confirmed the diagnosis of a B. pertussis respiratory infection. During hospitalization, he had fluctuant encephalopathy and post-tussive decerebration postures following paroxysms. He was treated with antibiotic therapy and finally sent home without residual neurological deficits. CONCLUSION: This case illustrates the biological plausibility of neurologic complications of pertussis in adults, which, albeit rare, can cause important morbidities. Future research should explore whether there are differences in the clinical presentation, risk factors and pathophysiology of the disease among adults or interventions aimed at preventing or treating pertussis encephalopathy.

[Analysis of mortality caused by tuberculosis in Medellín, Colombia, 2012]. / Análisis de la mortalidad por tuberculosis en Medellín, 2012.

INTRODUCTION: Tuberculosis is a relevant global public health problem. Although reports of the World Health Organization show decrease in overall mortality rates, Colombia and Medellin show no significant decline. OBJECTIVE: To describe the sociodemographic, clinical, diagnosis, and treatment characteristics of patients who died due to tuberculosis in Medellin, Colombia, during 2012. MATERIALS AND METHODS: A descriptive study of tuberculosis deaths reported in the city. RESULTS: 93 deaths were identified, of which 32 were confirmed as directly caused by tuberculosis (34.4%); in 23 deaths (24.7%) tuberculosis was an associated cause. Co-morbidities were found in 34 patients (61.7%), HIV being the most common with 18 cases important(32.7%). Social risk factors such as being homeless, drug addiction or having no fixed address were found in 32 cases (58.1%); and there were deficiencies in the healthcare system in 26 cases (47.2%). No meaningful delay in the onset of anti-tuberculosis treatment was found after the microbiological diagnosis; however, 64% of patients did not adhere to treatment. CONCLUSION: Mortality caused by tuberculosis in Medellin is a relevant problem associated with delays in diagnosis of the disease and lack of adherence to treatment.

Análisis de la mortalidad por tuberculosis en Medellín, 2012 / Analysis of mortality caused by tuberculosis in Medellín, Colombia, 2012

Introducción. La tuberculosis es uno de los principales problemas globales de salud pública. Aunque los reportes de la Organización Mundial de la Salud muestran un descenso en las tasas de mortalidad global, Colombia y la ciudad de Medellín no muestran reducciones significativas. Objetivo. Describir las características sociodemográficas, clínicas y de diagnóstico y tratamiento, de los pacientes fallecidos por tuberculosis en Medellín en el 2012. Materiales y métodos. Es un estudio descriptivo de las muertes por tuberculosis reportadas en Medellín durante el 2012. Resultados. El número de muertes fue de 93, de las cuales, 32 (34,4 %) se confirmaron como muertes directas por tuberculosis y 23 (24,7 %) como asociadas a esta enfermedad. En 34 (61,7 %) de los pacientes hubo alguna enfermedad concomitante, siendo el sida la más importante (18, 32,7 %). Se detectaron factores de riesgo social como ser habitante de la calle, farmacodependencia o carencia de domicilio fijo, en 32 casos (58,1 %), y aspectos que afectaron el proceso de atención de los servicios de salud, en 26 (47,2 %). Hubo un retraso de 40 días (rango intercuartílico: 19 a 84) entre el inicio de los síntomas y el diagnóstico. No se encontró retraso significativo en el inicio del tratamiento antituberculoso después del diagnóstico microbiológico; sin embargo, el porcentaje de incumplimiento del tratamiento fue de 64%. Conclusión. La mortalidad por tuberculosis en Medellín es un problema relevante que está relacionado con retrasos en el diagnóstico de los casos y con el cumplimiento del tratamiento.

Introduction: Tuberculosis is a relevant global public health problem. Although reports of the World Health Organization show decrease in overall mortality rates, Colombia and Medellin show no significant decline. Objective: To describe the sociodemographic, clinical, diagnosis, and treatment characteristics of patients who died due to tuberculosis in Medellin, Colombia, during 2012. Materials and methods: A descriptive study of tuberculosis deaths reported in the city. Results: 93 deaths were identified, of which 32 were confirmed as directly caused by tuberculosis (34.4%); in 23 deaths (24.7%) tuberculosis was an associated cause. Co-morbidities were found in 34 patients (61.7%), HIV being the most common with 18 cases important(32.7%). Social risk factors such as being homeless, drug addiction or having no fixed address were found in 32 cases (58.1%); and there were deficiencies in the healthcare system in 26 cases (47.2%). No meaningful delay in the onset of anti-tuberculosis treatment was found after the microbiological diagnosis; however, 64% of patients did not adhere to treatment. Conclusion: Mortality caused by tuberculosis in Medellin is a relevant problem associated with delays in diagnosis of the disease and lack of adherence to treatment.