Lung TB diagnosing difficulties in HIV-infected patients

Abstract

The HIV epidemic had a huge impact on the TB epidemic situation in the XXI century. Tuberculosis is developing more and more often in patients with HIV, and this is a serious problem for the society and health care system. When monitoring HIV+ patients, it is important to timely detect tuberculosis, the diagnostics of which may be very difficult. In case of progressing immunosuppression, specific clinical and radiological features are seen, often with no bacterial excretion in sputum and negative skin tests during immunodiagnostics.

Objective of the study. To show the prospects of using the T-SPOT®.TB test using clinical examples.

Materials and methods. Two clinical examplesof HIV+ patients in severe immunodeficiency stage are presented, these
patients are linked to care at the AIDS center. All patients were examined for tuberculosis with T-SPOT®.TB.

Results. At the initial diagnostic stage, minimal changes were detected on CT that could point to tuberculosis, MBT were not detected, but T-SPOT®.TB gave positive results. The diagnosis of tuberculosis has not been confirmed. Upon further observation, with the same X-ray picture, MBT were detected, and pulmonary tuberculosis verified. In these cases, the positive result of T-SPOT®.TB indicated the activity of tuberculosis infection before the detection of MBT.

Conclusion. Clinical cases reflect the difficulties of diagnosing tuberculosis in patients with HIV infection with high level of immunosuppression. The introduction of diagnostic tests based on the ELISPOT technique (T-SPOT®.TB) is highly promising, especially in the absence of bacterial excretion in sputum and limited changes in lung tissue.