Background: In pulmonary tuberculosis (PTB) there are certain radiographic patterns as the cavitation, which has been considered “pathognomonic” of this disease. However, this is controversial in HIV positive patients coinfected with PTB because several studies found that there are patterns associated with CD4+ T lymphocyte count greater or slower than 200 cells/mm3 . Objectives: To determine the association between pulmonary radiographic patterns and CD4+T lymphocyte count in HIV patients coinfected with PTB. Methods: Cross- sectional study conducted at the Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) of Lima, Perú, from 1994 to 2011. We worked with the online database provided by the Department of Infectious Diseases in which only 241 patients were eligible. We excluded 112 patients who did not meet the inclusion criteria established. The radiological patterns were determined from the radiology report of the medical record database, diagnosis of HIV was determined by ELISA and Western Blot test and the CD4+ count by flow cytometry. The bivariate analysis was performed using Fisher’s exact test and we considered a p <0.05 as significant. Results: The sample consisted of 129 patients, of which 77.5% were men. There was a median age of 37 years for the age of diagnosis of PTB (IQR= 30.5- 44) and the median CD4+ T lymphocyte count was 59 cells/mm3 (IQR= 22- 206). Patients with CD4+ T lymphocyte count <200 cells/mm3 represented 73.6% (n= 95). Interstitial pattern was the most frequent (25.6%) pattern of the sample, followed by the normal pattern (23.7%). Among the main findings, the pattern that had a higher prevalence of patients with CD4+ counts ≥ 200 cells/mm3 was the normal patterns with 35.14%. While the pattern that provided more patients with CD4 + counts <200 cells/mm3 was the pleural pattern with 83.33% within this group. We found no significant p value in the association between pulmonary radiographic patterns and the level of CD4+ T lymphocytes count. Conclusions: No association was found between radiological patterns and CD4+ lymphocyte count. It is possible to find any pattern in this group of patients. We do not recommend trying to determine the CD4+ count from the chest radiograph in HIV patients coinfected with PTB. It would be important to conduct further multicenter studies / En la tuberculosis pulmonar (TBP), ciertos patrones radiológicos como el cavitario han sido considerados “patognomónicos” de esta enfermedad. Sin embargo, esto resulta controversial en pacientes VIH positivos coinfectados con TBP ya que diversos estudios encontraron que existen patrones asociados a niveles de linfocitos T CD4+ mayores y menores de 200 células/mm3. El estudio de corte transversal realizado en el Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) de la ciudad de Lima, Perú, durante los años 1994 al 2011. Se trabajó con la base de datos virtual del Servicio de Infectología de los cuales solo 241 pacientes fueron elegibles. Se excluyeron 112 pacientes que no cumplieron con los criterios de inclusión. Los patrones radiológicos se determinaron a partir del informe radiológico de la historia clínica, el diagnóstico de VIH se determinó mediante los test de ELISA y Western Blot y el conteo de linfocitos T CD4+ a través de citometría de flujo. El análisis bivariado se realizó con el test exacto de Fisher. Se consideró un p significativo con un valor <0.05. La población estuvo conformada por 129 pacientes, de los cuales el 77,5% fueron hombres. Se halló una mediana de 37 años para la edad de diagnóstico de TBP (RI= 30,5- 44), mientras que para el conteo de linfocitos T CD4+ la mediana resultó ser 59 (RI= 22- 206). El 73,6% (n= 95) de los pacientes presentaban un conteo de linfocitos T CD4+ <200 células/mm3. El patrón intersticial fue el más frecuente (25,6%) de la muestra, seguido por el patrón normal (23,7%). Dentro de los hallazgos principales, el patrón que presentó mayor predominio de pacientes con CD4+ ≥200 células/mm3 fue el normal con un 35,14%. Mientras que el patrón que presentó mayor cantidad de pacientes con CD4+ <200 células/mm3 fue el patrón pleural con un 83.33% dentro de este grupo. / Tesis
| Identifer | oai:union.ndltd.org:PERUUPC/oai:repositorioacademico.upc.edu.pe:10757/322290 |
| Date | 30 June 2014 |
| Creators | Vega Villanueva, Karen Isabel, Cortez Bazán, Nathaly |
| Contributors | Carreazo Pariasca, Nilton Yhuri |
| Publisher | Universidad Peruana de Ciencias Aplicadas (UPC), PE |
| Source Sets | Universidad Peruana de Ciencias Aplicadas (UPC) |
| Language | Spanish |
| Detected Language | English |
| Type | info:eu-repo/semantics/bachelorThesis |
| Format | application/msword, application/pdf |
| Source | Universidad Peruana de Ciencias Aplicadas (UPC), Repositorio Académico UPC |
| Rights | info:eu-repo/semantics/openAccess, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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