Abdominal Sonographic Findings in Severely Immunosuppressed Human Immunodeficiency Virus-Infected Patients Treated for Tuberculosis

Harriet Nalubega Kisembo, Michael Grace Kawooya, Chris Kenyon, William Worodria, Robert Colebunders

Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Medicine, Makerere University, Kampala, Uganda.
Department of Radiology, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Radiology, Mulago National Referral and Teaching Hospital, Kampala, Uganda.
University of Antwerp, Antwerpen, Belgium.

DOI: 10.4236/jtr.2014.22008                

Abstract

Objective: We describe the abdominal sonographic findings among patients with HIV-tuberculosis (TB) co-infection with advanced immune suppression before initiation of ART and relate these findings to the patients’ abdominal symptoms and CD4 T-cell count. Methods: Consecutive HIV-TB co-infected patients, qualifying for ART, were prospectively enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Programme clinic in Kampala, Uganda. An abdominal ultrasound was performed at enrolment. Results: A total of 209 HIV-TB co-infected patients (76% with pulmonary, 19% with extrapulmonary TB and 5% with extrapulmonary and pulmonary TB) underwent an abdominal ultrasound scan. Only 49 patients (23.4%) had a normal abdominal ultrasound. The following sonographic abnormalities were found: multiple lymphadenopathy (38%), splenomegaly (18%), renal abnormalities (14%), gastro-intestinal tract abnormalities (thickened bowel loops, appendicitis) (13%), splenic abscesses (13%) and ascites (6%). The commonest groups of enlarged lymph nodes were in the porta-hepatis (19%) and peripancreatic (17%) area and 80% of the enlarged lymph nodes were hypoechoic. Conclusion: Most patients with advanced immune suppression and HIV-TB co-infection have sonographic evidence of generalized TB with abdominal involvement, therefore Ultrasound may assist in the early diagnosis of disseminated TB.

Keywords

Abdominal Sonography, Severe Immunosuppression, HIV-TB Co-Infection

Conflicts of Interest

The authors declare no conflicts of interest.

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