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


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.

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Kisembo, H. , Kawooya, M. , Kenyon, C. , Worodria, W. and Colebunders, R. (2014) Abdominal Sonographic Findings in Severely Immunosuppressed Human Immunodeficiency Virus-Infected Patients Treated for Tuberculosis. Journal of Tuberculosis Research, 2, 65-74. doi: 10.4236/jtr.2014.22008.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lawn, S.D., Badri, M. and Wood, R. (2005) Tuberculosis among HIV-Infected Patients Receiving HAART: Long Term Incidence and Risk Factors in a South African Cohort. AIDS, 19, 2109-2116.
[2] Sharma, S.K., Mohan, A. and Kadhiravan, T. (2005) HIV-TB Co-Infection: Epidemiology, Diagnosis, & Management. Indian Journal of Medical Research, 121, 550-567.
[3] O’Keefe, E.A., Wood, R., Van Zyl, A. and Cariem, A.K. (1998) Human Immunodeficiency Virus-Related Abdominal Pain in South Africa. Aetiology, Diagnosis, and Survival. Scandinavian Journal of Gastroenterology, 33, 212-217.
[4] Iliyasu, Z. and Babashani, M. (1998) Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria. Journal of Epidemiology, 19, 81-87.
[5] Lucas, S.B., Peacock, C., Beaumel, A., Djomand, G., N’Gbichi, J.M., et al. (1993) The Mortality and Pathology of HIV Infection in a West African City. AIDS, 7, 1569-1579.
[6] Tsibwabwa, E.T., Mwaba, P., Bolge-Talyor, J., Zumla, A. (2000) Four-Year Study of Abdominal Ultrasound in 900 Central African Adults with AIDS Reffered for Diagnostic Imaging. Abdom Imaging, 25, 290-296.
[7] Obajimi, M.O, Atalabi, M.O., Ogbole, G.I., Adeniji-Sofoluwe, A.T., Adekanmi, A.J., et al. (2008) Abdominal Ultrasound in HIV/AIDS Patients in Southwestren Nigeria. BMC Medical Imaging, 8, 5.
[8] Worodria, W., Massinga-Loembe, M., Mayanja, K.H., Namaganda, J., Kambugu, A., Manabe, Y.C., et al. (2011) Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART. Clinical and Development Immunology, 2011, Article ID: 758350.
[9] World Health Organization (2007) Improving the Diagnosis and Treatment of Smear-Negative Pulmonary and Extrapulmonary Tuberculosis among Adults and Adolescents. Recommendations for HIV-Prevalent and Resource Constrained Settings. WHO, Geneva.
[10] Manosuthi, W., Mankatitham, W., Lueangniyomkul, A., Ananworanich, J., Avihingsanon, A., et al. (2009) Clinical Case Definition and Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome. AIDS, 23, 2467-2471.
[11] Kisembo, H.N., Den Boon, S., Davis, J.L., Okello, R., Worodria, W., Cattamanchi, A., Huang, L. and Kawooya, M.G. (2012) Chest Rdiographic Findings of Pulmonary Tuberculosis in Severely Immunocompromised Patients with the Human Immunodeficiency Virus. The British Journal of Radiology, 85, e130-e139.
[12] Lee, J.K. (1989) Retroperitoneum in Computed Body Tomgraphy with MRI Correlation. 2nd Edition, Raven, New York, 707-753.
[13] Dewbury, K. (1996) The Spleen. In: Goldberg, B.B. and Pettersson, H., Eds., Ultrasonography, The NICER Institute, Oslo, 135-157.
[14] Mathieson, J.R., Wilson, S.R. and Charboneau, J.W. (Eds.) (1998) Diagnostic Ultrasound. 2nd Edition, Mosby, St. Louis.
[15] Brooks, M. (1996) The Liver. The NICER Institute, Oslo, 55-67.
[16] Kurtz, A.R.C., Cooper, H., Nisenbaum, H.L., Cole-Beuglet, C. and Medoff, J. (1980) Ultrasound Findings in Hepatitis. Radiology, 136, 717-723.
[17] Needleman, L., Kurtz, A.B., Rifkin, M.D., Cooper, H.S., Pasto, M.E. and Goldberg, B.B. (1986) Sonography of Diffuse Benign Liver Disease: Accuracy of Pattern Recognition and Grading. American Journal of Roentgenology, 146, 1011-1015.
[18] Needleman, L. (1988) Diffuse Benign Liver Disease. Clinics in Diagnostic Ultrasound, 23, 57-73.
[19] Peter, L., Glenn, C., Scheske, A. and Mathieson, J.R. (1996) The Gallbladder and Biliary Ducts. In: Goldberg, B.B. and Pettersson, H., Eds., Ultrasonography, The NICER Institute, Oslo, 85.
[20] World Health Organization (2009) Global Tuberculosis Control: Epidemiology, Strategy, Financing. WHO Report 2009, WHO, Geneva.
[21] Heller, T., Goblirsch, S., Wallrauch, C., Lessells, R. and Brunetti, E. (2010) Abdominal Tuberculosis: Sonographic Diagnsois and Treatment Response in HIV-Positive Adults in Rural South Africa. International Journal of Infectious Diseases, 14, e108-e112.
[22] Jain, R., Sawhney, S., Bhargava, D.K. and Berry, M. (1995) Diagnosis of Abdominal Tuberculosis: Sonographic Findings in Patient with Early Disease. American Journal of Roentgenology, 165, 1391-1395.
[23] Sinkala, E., Gray, S., Zulu, I., Mudenda, V., Zimba, L., Vermund, S.H., Drobniewski, F. and Kelly, P. (2009) Clinical and Ultrasound Features of Abdominal Tuberculosis in HIV Positive Adults in Zambia. BMC Infectious Diseases, 9, 44. http://dx.doi.org/10.1186/1471-2334-9-44
[24] Chakraborty, P.P. and Bandyopadhyay, D. (2009) Utility of Abdominal Ultrasonography in HIV Patients. Singapore Medical Journal, 50, 710-714.
[25] World Health Organization (2007) Improving the Diagnosis and Treatment of Smear-Negative Pulmonary and Extrapulmonary Tuberculosis among Adults and Adolescents. Recommendations for HIV-Prevalent and Resource-Constrained Setting. WTO, Geneva.
[26] Kawooya, M.G. (2013) Abdominal Ultrasound Findings in HIV and Tuberculosis: Literature Review. Imaging in Medicine, 5, 265-274.
[27] Kawooya, M.G., Muyinda, Z., Byanyima, R. and Malwadde, E.K. (2008) Abdominal Ultrasound Findings in HIV Patients: A Pictorial Review. Ultrasound, 16, 62-72.
[28] Uygur-Bayramicli, O., Dabak, G. and Dabak, R. (2003) A Clinical Dilemma: Abdominal Tuberculosis. World Journal of Gastroenterology, 9, 1098-1101.
[29] Marjanović, H.-B., Pecić, V., Marjanović, G. and Marjanović, V. (2008) Abdominal Localization of Tuberculosis and the Role of Surgery. Biology and Medicine, 15, 51-55.
[30] Patel, M.N., Beningfield, S. and Burch, V. (2011) Abdominal and Pericardial Ultrasound in Suspected Extrapulmonary or Disseminated Tuberculosis. South African Medical Journal, 101, 39-42.
[31] Sculier, D., Vannarith, C., Pe, R., Thais, S., Kanara, N., Borann, S., Cain, K.P., Lynen, L. and Varma, J.K. (2010) Performance of Abdominal Ultrasound for Diagnosis of Tuberculosis in HIV-Infected Persons Living in Cambodia. Journal of Acquired Immune Deficiency Syndromes, 55, 500-502.
[32] Khan, R., Abid, S., Jafri, W., Abbas, Z., Hameed, K. and Ahmad, Z. (2006) Diagnostic Dilemma of Abdominal Tuberculosis in Non-HIV Patients: An Ongoing Challenge for Physicians. World Journal of Gastroenterology, 12, 6371- 6375.
[33] Symeonidou, C., Standish, R., Sahdev, A., Katz, R.D., Morlese, J. and Malhotra, A. (2008) Imaging and Histopathologic Features of HIV-Related Renal Disease. RadioGraphics, 28, 1339-1354.
[34] Sanai, F.M. and Bzeizi, K.I. (2005) Systematic Review: Tuberculous Peritonitis-Presenting Features, Diagnsotic Strategies and Treatment. Alimentary Pharmacology & Therapeutics, 22, 685-700.
[35] Tongsong, T., Sukpan, K., Wanapirak, C., Sirichotiyakul, S. and Tongprasert, F. (2007) Sonographic Features of Female Pelvic Tuberculous Peritonitis. Journal of Ultrasound in Medicine, 26, 77-82.
[36] Agarwal, D., Narayan, S., Chakravarty, J. and Sundar, S. (2010) Ultrasonography for Diagnosis of Abdominal Tuberculosis in HIV-Infected People. Indian Journal of Medical Research, 132, 77-80.
[37] Collado, C., Stirnemann, J., Ganne, N., Trinchet, J.-C., Cruaud, P., Barrat, C., et al. (2005) Gastrointestinal Tuberculosis: 17 Cases Collected in 4 Hospitals in the Northestern Suburb of Paris. Gastroentérologie Clinique et Biologique, 29, 419-424. http://dx.doi.org/10.1016/S0399-8320(05)80796-1

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