Pcrandthe misdiagnosis of active tuberculosis

A. Maccabruni, D. Caselli, P. Marone, G. Michelone, A. Deicas

Research output: Contribution to journalArticle

Abstract

Introduction: Thens is a strong epidemiological evidence linking the outbreak of HIV infection to the rising incidence of tubercolosis (TB).This increase in rate of tubercolosis was initially reported only in adufts as a result of immunosoppression-induced reactivation of latent infection; more recently a rising number of cases ofTB also m HIV-infected children has been reported.The most important laboratory test for the diagnosis and management of TB is the mycobacterial culture. A promising method for rapid diagnosis is represented by the technique of polymerase chain reaction (PCR) for detection of M.tubercolosis DMA in sputum and in other clinical specimens, but the predictive value of this test remains up to now unclear Case report R.F. is a 7-year-old white boy, perinatally HIV infected with severe immunosoppression (CD4 count <50mm3).He came to the Hospital wrth fever productive cough and severe asthenia: a chest X-ray film showed a round cavitation in the right upper lobe. Sputum, gastric aspirates, urine and stool cultures resulted negative for M.tubercolosis, as well as for non-tuberculous mycobacteria.Two sputum specimens were positive for M.tuberculosis by PCR On the basis of the results of the PCR test alone, empiric therapy was started with isoniazide, rifampin and pyramzinamide. After a month of antituberculous treatment the patients still presented with intermittent fever and nespiratory distress. As the blood and sputum cultures resulted positive for Pseudomonas aeruginosa. the antituberculous treatment was suspended and an adequate antibiotic therapy was initiated. Some weeks later the patient was persistenly apiretic and clinically almost asymptomatic, the chest film at that time showed a significant reduction of the pulmonary cavitation. Conclusion: The reported case confirms thatTB disease shouldn't be diagnosed on the basis of the PCR test alone; particularly in HIVinfected and immunocompromised patients it is important to avoid unnecessary and sometimes toxic drugs and to prwide a prompt and adequate treatment of infectious complications.

Original languageEnglish
Pages (from-to)375
Number of pages1
JournalPediatric AIDS and HIV Infection
Volume7
Issue number5
Publication statusPublished - 1996

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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