Clinical Manifestations and CD4 Counts of Tuberculosis in Human Immunodeficiency Virus-infected and Un-infected among Newly Diagnosed Patients in Mombasa, Kenya

Background: Tuberculosis is a disease with protean manifestations. The clinical presentation of tuberculosis can mimic several diseases and can be a diagnostic problem even in endemic areas. Virulence and dose of the infecting mycobacterium, the immune status of the host, the organ systems(s) involved, all influence the clinical manifestations of tuberculosis.

Aim: This study was at aimed assessing clinical manifestations and CD4 counts of TB patients with or without HIV co-infection.

Study Design: Hospital and laboratory based cross-sectional study was carried between May 2011 and November 2013 in Coast General Referral hospital, Tudor, Port-Reitz, Mlaleo, Likoni and Mikindani districts and Sub-districts hospitals.

Methodology: Tuberculosis was diagnosed following standard clinical bacteriological and radiological procedures. Sputa from 500 tuberculosis suspects underwent mycobacteriologic evaluation using Ziel-Nelsen smear microscopy, Lowestein and Jensen and BACTEC MGIT 960 culturing. Consenting participants were screened for HIV infection by enzyme -linked immunosorbent assay. Data collected from group were compared using univariate and multivariate analysis. The level of significance was set at p<0.05 and for each statistically significant, odds ratios and confidence interval were computed.

Results: A total of 210/500 (42%) of the tuberculosis suspects had mycobacterial disease and 78/210 (37.1%) were HIV co-infected. Most presenting symptoms in TB patients with or without HIV was cough 50%, constitutional symptoms 42.3%, fever 29.5% and weight loss 31.4% and night sweats (90.9%). Regarding clinical signs, pallor 50.4%, night sweats 35.2% and respiratory signs 16.7% were common and significantly associated with HIV -positive serology. Oral thrush (OR=11.04; 95% CI: 3.01-17.20), Gastro intestinal symptoms (OR=8.97; 95% CI: 3.45-23.41) and constitutional symptoms (OR=7.17; 95% CI: 2.24-15.2) were independent predictors of HIV-positive serology. Majority of the patients with TB-HIV co-infection had CD4+T cell count <200 cells/mm3 accompanied by night sweats. Tuberculosis patients had statistically significant higher mean CD4+T cell counts (t=5.6, df=461, p<0.05) and higher leukocyte counts (t=3.8, df=472, p<0.05) than HIV/AIDS tuberculosis co-infected patients.

Conclusion: Co-infection with HIV was very high in patients with TB. The presence of chronic cough more than one month, night sweats, fever and pallor may assist in identify TB patients with HIV infection. Physicians should be aware of this pattern of presentation and the atypical findings on investigation for early diagnosis and treatment. CDT+T cell counts were significantly elevated in TB patients than TB-HIV co-infection.