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Abstract
Background: Tuberculosis (TB) is the leading cause of infectious death worldwide with 1.5 million deaths annually and nearly 1/4th of the world’s population (1.7 billion) infected with latent tuberculosis infection (LTBI) in 2014. Its diagnosis conventionally relies on tuberculin skin testing (TST), and Interferon-Gamma Release Assay (IGRA) which relies on the production of Interferon Gamma (IFN-y) in response to Mycobacterium tuberculosis (MTB) specific antigens. IGRA is a useful tool for detecting latent TB disease, and can be used as an adjunct for the diagnosis of active TB cases. Increases in IFN-y levels might support the diagnosis of a new TB infection. Human Immunodeficiency Virus infection (HIV) increases the risk of active-TB and early detection of LTBI is imperative for accurate diagnosis and timely treatment. Early detection of LTBI with QFT-G has similar sensitivity & accuracy in TB patients regardless of their HIV status. Early detection of LBTI is needed for preventative therapy and treatment regardless of skin test result. The aim of this case report is to highlight the use of different diagnostic TB strategies in patients with advanced HIV.
Case Presentation: We present the case of a 37-year-old male under US Marshall custody who presented to the hospital from a correctional facility with fever and lethargy. Imaging studies and physical exam revealed a right-sided testicular and pancreatic head mass, and later multiple metastatic deposits in bilateral lung fields. In preparation of initiating chemotherapy, this patient developed progressive worsening respiratory distress requiring intubation and admission to the medical intensive care unit (MICU). Intubation was initially refused, and consent through family members faced legal obstacles from law enforcement. Consent was delayed but finally was granted by law enforcement. The HIV diagnosis was initially unknown to his physicians and health care personnel as he was encephalopathic and unable to provide this information until later in the hospitalization after successful extubation. The diagnosis of TB was entertained when the patient was re-intubated for airway protection in the setting of septic shock and re-admitted to the MICU. Three acid-fast smears were performed with positive results, however IGRA testing resulted inconclusive. Nucleic acid amplification testing was performed, which resulted positive for tuberculosis infection, however this resulted in a postmortem status after the patient’s family transitioned him to comfort care measures due to acute renal failure.
Conclusion: This case illustrates the complexity of tuberculosis diagnosis in the patient with severe AIDS and non-specific imaging findings. While not endemic to the United States, Texas has a higher TB case rate than the national rate with 20% of its cases reported in the border counties, a larger share than expected considering around 9.5% of the Texas population reside in a border county. TB infection remains an ongoing, global battle and medical practitioners should remain vigilant in identifying and diagnosing this disease.
Presentation Type
Poster
Recommended Citation
Preciado, Hector D.; Torres, Maria E.; Siddiqui, Muhammad A.; Salloum, Liza; Gelpi, Lee; and Campo Maldonado, Jose E., "Houston, We Have a Problem: Diagnostic Difficulties in the AIDS Patient with Tuberculosis Infection" (2024). Research Colloquium. 83.
https://scholarworks.utrgv.edu/colloquium/2024/posters/83
Included in
Bacterial Infections and Mycoses Commons, Infectious Disease Commons, Medical Microbiology Commons
Houston, We Have a Problem: Diagnostic Difficulties in the AIDS Patient with Tuberculosis Infection
Background: Tuberculosis (TB) is the leading cause of infectious death worldwide with 1.5 million deaths annually and nearly 1/4th of the world’s population (1.7 billion) infected with latent tuberculosis infection (LTBI) in 2014. Its diagnosis conventionally relies on tuberculin skin testing (TST), and Interferon-Gamma Release Assay (IGRA) which relies on the production of Interferon Gamma (IFN-y) in response to Mycobacterium tuberculosis (MTB) specific antigens. IGRA is a useful tool for detecting latent TB disease, and can be used as an adjunct for the diagnosis of active TB cases. Increases in IFN-y levels might support the diagnosis of a new TB infection. Human Immunodeficiency Virus infection (HIV) increases the risk of active-TB and early detection of LTBI is imperative for accurate diagnosis and timely treatment. Early detection of LTBI with QFT-G has similar sensitivity & accuracy in TB patients regardless of their HIV status. Early detection of LBTI is needed for preventative therapy and treatment regardless of skin test result. The aim of this case report is to highlight the use of different diagnostic TB strategies in patients with advanced HIV.
Case Presentation: We present the case of a 37-year-old male under US Marshall custody who presented to the hospital from a correctional facility with fever and lethargy. Imaging studies and physical exam revealed a right-sided testicular and pancreatic head mass, and later multiple metastatic deposits in bilateral lung fields. In preparation of initiating chemotherapy, this patient developed progressive worsening respiratory distress requiring intubation and admission to the medical intensive care unit (MICU). Intubation was initially refused, and consent through family members faced legal obstacles from law enforcement. Consent was delayed but finally was granted by law enforcement. The HIV diagnosis was initially unknown to his physicians and health care personnel as he was encephalopathic and unable to provide this information until later in the hospitalization after successful extubation. The diagnosis of TB was entertained when the patient was re-intubated for airway protection in the setting of septic shock and re-admitted to the MICU. Three acid-fast smears were performed with positive results, however IGRA testing resulted inconclusive. Nucleic acid amplification testing was performed, which resulted positive for tuberculosis infection, however this resulted in a postmortem status after the patient’s family transitioned him to comfort care measures due to acute renal failure.
Conclusion: This case illustrates the complexity of tuberculosis diagnosis in the patient with severe AIDS and non-specific imaging findings. While not endemic to the United States, Texas has a higher TB case rate than the national rate with 20% of its cases reported in the border counties, a larger share than expected considering around 9.5% of the Texas population reside in a border county. TB infection remains an ongoing, global battle and medical practitioners should remain vigilant in identifying and diagnosing this disease.