Mycobacteremia in tuberculosis patients with HIV infection

Abstract

Background: Mycobacteremia in HIV positive tuberculosis patients is associated with extra-pulmonary tuberculosis and disseminated tuberculosis. Objective: To study the occurrence of mycobacteremia among HIV-infected patients with tuberculosis (both pulmonary and extra-pulmonary forms) using radiometric BACTEC method. Methods: HIV positive patients admitted to the Government Hospital of Thoracic Medicine with a clinical diagnosis of tuberculosis were screened. HIV serology was reconfirmed using ELISA (two different tests) at Tuberculosis Research Centre. Five ml of venous blood was collected on the day of admission to the ward before start of anti-tuberculosis therapy. Results: Of the 105 patients screened, 85 were were found to be eligible for analysis. Patients were aged between 20-40 years, with a male preponderance (5:1). Pulmonary tuberculosis was the predominant form of tuberculosis (85%), while 15% had associated extra-pulmonary involvement. Eight-four percent of the patients had CD4 counts of less than 200 cells/mm³, with 42% being below 50 cells/mm³. Four of the 85 patients were blood culture positive; three were identified as M.tuberculosis and one as Mycobacterium phlei. Conclusions: Mycobacteremia was detected in 4% of HIV positive patients with tuberculosis. All of them were immunosuppressed with CD4 counts of <50 cells/m³. More work needs to be done in India to understand the risk factors and outcome of patients with mycobacteremia.