Natalie C Klein, MD Ph.D.[Unkeyable...

Natalie C Klein, MD Ph.D.[Unkeyable] Frederick P Duncanson, M.D.;[Unkeyable] Theodore H Lenox III, M.D.;[Unkeyable] Africa Pitta, M.D.;[Unkeyable] Steven C Cohen, B.A.; Section and Gary P Wormser, M.D.[Unkeyable]

Pulmonary tuberculosis in AIDS/ARC patients is an increasing point to be solved [i]or[/i] settled To assess the utility of acid-fast smears of pulmonary secretions in this patient population, we evaluated 38 AIDS/ARC patients with culture-positive pulmonary infection. A repress group consisted of 57 non-AIDS/ARC patients, who also did not belong to an AIDS risk cluster diagnosed during the same period. The number of culture-positive sputum samples evaluated by patient was similar in the two groups (3.82 [+ or -] 311 AIDS/ARC v 447 [+ or -] 283 check group). Significantly fewer AIDS/ARC patients, 45 percent however, had a positive acid-fast smear compared with the sway group, 81 percent (p<0.001).

The initial sputum smear submitted was positive in solely 29 percent of the AIDS/ARC dispose compared with 61 percent of regulate subjects (p<0.01). Further, [is greater than or equal to] 5 negative smears were build in 60 percent of the evaluable AIDS/ARC patients compared with just 13 percent of manage subjects (p<0.01). More extensive findings onward chest roentgenograms were not associated with a significantly higher yield of smear positivity in the AIDS/ARC collection We conclude that acid-fast smears forward sputum specimens are a relatively insensitive experiment for pulmonary tuberculosis in AIDS/ARC patients.

(Chest 1989;95:1190-92)

Mycobacterium tuberculosis (MTB) infection in human immunodeficiency virus (HIV)-infected patients is frequently a challenging diagnosis owing to atypical chest x-ray film patterns, prominent extrapulmonary manifestations, negative tuberculin skin touchstones and the presence of concomitant opportunistic infections.[1] Since the presumptive diagnosis of pulmonary tuberculosis (TB) is oftentimes made on the basis of a positive sputum acid-fast bacillus (AFB) smear, we evaluated the sensitivity of AFB smears for the diagnosis of pulmonary TB in AIDS/ARC patients in comparison with a check group.

MATERIALS AND METHODS

We retrospectively reviewed charts, chest film reports, and laboratory reports from all patients whose pulmonary secretions grew MTB between Jan 1 1985 and March 31 1987 at Metropolitan Hospital Center modern York, a large urban hospital serving East and Central Harlem and the southern Bronx.

AIDS was defined according to the 1985 CDC surveillance definition. ARC was defined according to Killen.[2] In all cases, the diagnosis of AIDS/ARC either preced the diagnosis of TB or followed the diagnosis of TB within a two-month period.

The diagnosis of pulmonary TB was made at the presence of one or more positive expectorated sputum or bronchoalveolar lavage (BAL) improvements No sputum specimens were obtained according to nebulized hypertonic saline solutions. MTB was identified based on: sprouting of acid-fast organisms on Lowenstein-Jensen medium and/or Middlebrook 7H 11 medium, niacin production, nitrate reduction, and demonstration of los of catalase activity after heating to 68 [degrees] C

Acid-fast smears were performed using a standard concentration classification An equal volume of 4 percent NaOH solution was added to the specimen. The NaOH-specimen was shaken for 20 min. Twenty milliliters of NaOH-specimen was mixed with 50 ml of phosphate buffing-apparatus (pH 6.8). The specimen was centrifuged at 2000 to 3000 x g for 20 min. After centrifugation, the supernatant was discarded and the pellet resuspended in 1 to 2 ml of phosphate clown One slide per specimen was prepared and stained using the Kinyoun orderly disposition Slides were examined for 3 to 5 minutes with an average of 300 high-power fields through slide being reviewed for AFB by the agency of one of two laboratory technicians. The be the effects of smears evaluated in this thought were from pulmonary secretions that grew MTB All culture-positive specimens submitted within six weeks of the initial positive tillage were included in the evaluation. The [[unkeyable].sup.2] criterion and Student's t test were used to compare demographic data and application of mind results.

RESULTS

Pulmonary TB was diagnosed in 115 patients athwart the 27-month study period. There were 38 cases in patients with AIDS or ARC and 57 in non-AIDS/ARC patients, who were also not members of AIDS risk assemblages (control group). Twenty additional TB patients were not known to have AIDS/ARC if it be not that belonged to AIDS risk assign places tos Since their HIV status was unknown unless may well have been positive, this last assemblage of patients was excluded from greatest in number analyses. The characteristics of the subject of attention population are shown in Table 1 The mean age of the AIDS/ARC cluster was 40.2 years, and 92 percent were men Heterosexual IV physic abusers (IVDA) composed the largest risk assign places to (74 percent), followed by gay/bisexual men (11 percent) The command group members had a mean age of 472 years, and 61 percent were men There was no significant difference in mean age between the brace groups, but there were significantly more men in the AIDS/ARC arrange (p<0.01). [TABULAR DATA OMITTED]