A 31-year-old HIV-Positive Man with Extensive Travel History, with Cough and Night Sweats

Abstract Background Tuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that Tuberculosis is one of the top 10 causes of death worldwide. There are various factors that have made the eradication of tuberculosis in the Bahamas difficult such as high rates of HIV infection and immigrants migrating from countries with high TB prevalence. In understanding the epidemiology and risk factors of TB cases in the Bahamas, the development of protocols can improve screening procedures and decrease disease burden. Methods A retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014–2016 and all cases were evaluated for demographics, risk factors, clinical manifestation, method of diagnosis, symptoms, and treatment outcomes. Results Of the 189 cases of notified tuberculosis between 2014 and 2016, 46 cases were reported in 2014, 60 cases in 2015 and 83 cases in 2016. The mean age was 37.96 (±18.20) years old. 164 (86.8%) presented with symptoms, 19 (10.1%) of cases were diagnosed by routine screening and 6 (3.2%) of cases were diagnosed by contact tracing. 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. 144 (76.2%) presented with cough, 84 (44.7%) weight-loss, 80 (42.3%) fever, 44 (23.3%) night sweats, 43 (22.8%) chills, 32 (16.9%) fatigue, and 25 (13.2%) hemoptysis. 126(66.7%) completed the full course of antibiotic therapy, 29(15.3%) patients expired before completing treatment and 18(9.5%) of patients defaulted. Conclusion HIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. We also advise screening HIV-positive patients for TB. Screening other high-risk groups such as migrant populations would also benefit to reduce the amount of latent TB cases which may progress to active TB. Disclosures All authors: No reported disclosures.

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Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa080 ◽

2020 ◽

Author(s):

Joyce B Der ◽

Daniel J Grint ◽

Clement T Narh ◽

Frank Bonsu ◽

Alison D Grant

Keyword(s):

Multivariable Analysis ◽

Cross Sectional Study ◽

Hiv Positive ◽

Symptom Duration ◽

Hiv Status ◽

Cross Sectional ◽

Missed Opportunities ◽

Tb Treatment ◽

Symptom Screening ◽

Night Sweats

Abstract Background We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana. Methods In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF. Results We enrolled 581 participants (median age 33 years [IQR: 24–48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08–23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24–17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result. Conclusion Opportunities for early identification of people with TB are being missed in health facilities in Ghana.

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Eosinophilia: clinical significance in HIV-infected individuals

International Journal of STD & AIDS ◽

10.1258/ijsa.2012.011409 ◽

2012 ◽

Vol 23 (9) ◽

pp. 635-638 ◽

Cited By ~ 8

Author(s):

M Sivaram ◽

A White ◽

K W Radcliffe

Keyword(s):

Important Determinant ◽

Parasitic Infection ◽

Cd4 Count ◽

Stool Examination ◽

Hiv Positive ◽

Positive Serology ◽

Developed Country ◽

Travel History ◽

The Relationship ◽

Urine Microscopy

This study was conducted to determine the relationship between eosinophilia and parasitic infection in HIV-infected individuals. HIV-positive patients attending an HIV clinic in Birmingham were recruited and classified as either eosinophilic (>400 eosinophils/mm3) or non-eosinophilic. A demographic and parasitic risk history was taken and clinical examination was performed. Urine and stool were examined for parasites, and blood samples taken for parasite serology. A total of 266 patients (96 eosinophilic and 170 non-eosinophilic) were recruited. Of 64 eosinophilic patients who had a stool examination, one (1.6%) was positive for both Strongyloides larvae and schistosomal eggs. Urine microscopy was negative in the 245 patients (88 eosinophilic, 157 non-eosinophilic) from whom a sample was available. Two hundred and sixty-three patients underwent serological investigation (96 eosinophilic and 167 non-eosinophilic): 13 (4.9%) were positive for schistosomiasis and three (1.1%) positive for Strongyloides. A significant association between eosinophilia and positive schistosomal serology was found ( P = 0.003): 11 (10.5%) were eosinophilic patients, while only four (2.3%) were non-eosinophilic patients. Eosinophilia was associated with a low nadir CD4 count ( P = 0.021) and prior AIDS-defining illness ( P = 0.041). In all, 7.8% of patients from a developing country and 5.3% of patients from a developed country with a travel history had positive parasitic serology. Eosinophilia in HIV-infected patients was significantly associated with positive serology for schistosomiasis, low nadir CD4 count and prior AIDS-defining illness. Geographical exposure is also an important determinant of positive parasitic serology.

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A 31-Year-Old HIV-Positive Business Traveller With Cough, Shortness of Breath and Night Sweats

Clinical Cases in Tropical Medicine ◽

10.1016/b978-0-7020-7879-8.00023-4 ◽

2022 ◽

pp. 61-63

Author(s):

Robert F. Miller

Keyword(s):

Hiv Positive ◽

Shortness Of Breath ◽

Night Sweats ◽

Business Traveller

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Papulonecrotic tuberculid in an HIV-positive patient

International Journal of STD & AIDS ◽

10.1258/095646207781568628 ◽

2007 ◽

Vol 18 (9) ◽

pp. 643-644 ◽

Cited By ~ 4

Author(s):

Victoria Akhras ◽

Gill McCarthy

Keyword(s):

Skin Biopsy ◽

Immunological Response ◽

Hiv Positive ◽

Papular Eruption ◽

The Face ◽

Night Sweats ◽

Focus Of Infection ◽

History Of ◽

Haematogenous Spread ◽

Systemic Symptoms

We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Papulonecrotic tuberculid is thought to be a immunological response to Mycobacterium bacillus components in a previously sensitized patient following haematogenous spread from a focus of infection elsewhere. Cultures from the skin are typically negative and there are no acid-fast bacilli seen, but mycobacterial DNA can be detected using polymerase chain reaction. This case is an example of the paradoxical activation of the immune system seen in patients with HIV. It highlights the importance of skin biopsy in patients with unexplained systemic symptoms and a rash, as the differential diagnosis can be wide in HIV.

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Tuberculosis among Health Care Workers

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.09.01 ◽

2019 ◽

Vol 4 (9) ◽

Keyword(s):

Health Care ◽

Health Care Workers ◽

Close Contact ◽

Risk Groups ◽

Hiv Positive ◽

Bacterial Disease ◽

Infected People ◽

Care Workers ◽

Night Sweats ◽

Latent Tb

Tuberculosis (TB) is a bacterial disease caused by Mycobacterium Tuberculosis. It spreads form one person to another through air. When infected people with TB cough, sneeze or spit, they propel the TB germs in the air. A person needs to inhale only a few of these germs to be infected. Evidence of TB has been reported in human remains dated thousands of years. About one quarter of the world’s population has latent TB, which means TB bacteria have infected people but are not (yet) ill with the disease and therefore cannot transmit the disease. Tb occurs in specific risk groups such as immigrants, HIV-positive patients, homeless patients, prisoners, and alcoholics. Health care workers, who face frequent occupational exposure, are at particularly high risk. When a person develops active TB, the symptoms (such as cough, fever, night sweats or weight loss) may be latent for many months. This can lead to delays in seeking care and transmission of the bacteria to others. People with active TB can infect 10-15 other people through close contact over the course of the course of a year. Without treatment, 45% of HIV- negative people with TB on average and nearly all HIV- positive people with TB will die. Transmission of tuberculosis (TB) in health care settings to both patients and health care workers has been reported from virtually every country of the world, regardless of local TB incidence. We are presenting the case of an asymptomatic 28- year-old Caucasian male from Europe who initially was being screened for TB for pre-employment purposes.

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