Chest
Tuberculous Pleurisy Is More Common in AIDS Than in Non-AIDS Patients With Tuberculosis
Section snippets
Materials and Methods
We identified all cases of pleural tuberculosis in South Carolina from 1988 through 1994 by reviewing the state tuberculosis registry. From this group, we identified those patients who were also HIV positive. All patients with tuberculosis are routinely offered HIV testing. Case information was obtained from the treating physicians and by review of the records. Patient confidentiality was maintained. These cases were reviewed retrospectively for clinical findings, test results, treatment, and
Results
From 1988 through 1994, there were 2,817 cases of tuberculosis in non-AIDS patients in South Carolina. Pleural involvement was diagnosed in 169 of 2,817 (6%) cases. There were 202 AIDS patients with tuberculosis. Twenty-two of 202 (11%) of the AIDS patients with tuberculosis had pleural involvement compared to 6% pleural involvement in non-AIDS patients (p=0.01). There were 19 definite cases and three probable cases of AIDS tuberculous pleuritis. During this time, there were 4,552 newly
Discussion
Among all patients with tuberculosis in South Carolina, the proportion with pleural involvement is greater in AIDS patients than in non-AIDS patients. This is an unexpected finding given the currently accepted pathophysiologic state of the disease. Since tuberculous pleurisy is thought to be primarily an immune reaction to tuberculin proteins in the pleural space, a lower incidence in AIDS patients because of impaired cell-mediated immunity would be expected. There are several possible
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Presented in part at the Annual Scientific Session of the American College of Chest Physicians, New York, October 30, 1995.