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題名 | Clinical Analysis of Mycobacterium Tuberculosis Infection in Patients with Acquired Immunodeficiency Syndrome=後天免疫缺乏症候群患者結核桿菌感染之臨床分析 |
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作者 | 邱昭佩; 王永衛; 郭英調; 刁翠美; 馮長風; 劉正義; Chiu, Chao-pei; Wang, Wing-wai; Kuo, Benjamin; Tiao, Tsui-mei; Fung, Chang-phone; Liu, Cheng-yi; |
期刊 | 微免與感染雜誌 |
出版日期 | 19991200 |
卷期 | 32:4 1999.12[民88.12] |
頁次 | 頁250-256 |
分類號 | 415.944 |
語文 | eng |
關鍵詞 | 後天免疫缺乏症候群; 結核桿菌; Mycobacterium tuberculosis infection; Acquired immunodeficiency syndrome; |
中文摘要 | 1990年1月至1998年7月,臺北榮民總醫院共120位HIV陽性患者住院過,其中有12例(10%)曾感染結核桿菌感染,平均年齡為38歲,發現結核菌感染時,已屬愛滋病末期,平均血中CD4數目為21/uL,血中亦具較高病毒量,胸部放射性影像學之臨床表現為多樣化,大部分(62.5%)表現為似初次感染,侵犯下肺部或瀰漫性浸潤,少數為上肺部(37.5%)侵犯,更少有開洞(1例)。此類病患常有肺外侵犯之傾向,大部分最常肺外侵犯為淋巴結,58.3%患者對傳統之抗結核菌藥物治療反應良好,因結核菌感染為可人與人間互相散布,且可治療及預防,且其在愛滋病患者之臨床表現與一般無免疫缺損患者結核菌感染之臨床表現較不典型,故需靠臨床醫師保持高度警覺心,以期達到早期診斷及早期治療。 |
英文摘要 | From January 1990 to July 1998, twelve patients (10%) among 120 patients with human immunodeficiency virus infection who were hospitalized in the Veterans General Hospital-Taipei, were proved to have Mycobacterium tuberculosis infection. The mean age of these patients was 38 years, range:25-62 years. All patients studied were in the advanced stage of acquired immunodeficiency syndrome (AIDS) with a mean circulatory CD4 lymphocyte count of 21/uL (range:0-64/uL) and a much higher HIV viral load at initial diagnosis of M. tuberculosis infection. Because of no significant difference in the HIV viral load between patients with active pulmonary tuberculosis and those with extrapulmonary tuberculosis in this study, dissemination of M. tuberculosis did not correlate directly with a hihg HIV viral load, but was possibly related to the virulence of the organism itself. Chest radiographic findings at initial diagnosis of pulmonary tuberculosis were variable and atypical. Most patients (62.5%) presented with a primary pattern (lower lobe or diffuse infiltrates), while hilar lymphadenopathy was noted in more than half of the patients and cavitation was less common (only one patient). Ten patients (83.8%) had extrapulmonary involvement; the most common site being the lymph nodes. Most patients with classic drug-sensitive tuberculosis responded well to conventional standard regiments of anti-tuberculosis therapy. Since tuberculosis is transmittable, treatable, and possibly preventable, moreover the clinical presentation of tuberculosis in the patients with AIDS may be atypical and unusual, clinical physicians must keep an alert dealing with these patients for early identification and early treatment. |
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