Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients

• Published in: Tubercle and lung disease 1996, Vol.77 (3), p.244-249
• Main Authors: Di Perri, G., Cazzadori, A., Vento, S., Bonora, S., Malena, M., Bontempini, L., Lanzafame, M., Allegranzi, B., Concia, E.
• Format: Article
• Language: English
• Subjects: Adult; AIDS-Related Opportunistic Infections - immunology; AIDS-Related Opportunistic Infections - microbiology; AIDS-Related Opportunistic Infections - pathology; AIDS/HIV; Bronchoscopy; CD4 Lymphocyte Count; Female; human immunodeficiency virus; Humans; Male; Mycobacterium tuberculosis - isolation & purification; Retrospective Studies; Tuberculin Test; Tuberculosis, Pulmonary - immunology; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - pathology
• ISSN: 0962-8479; 1532-219X
• DOI: 10.1016/S0962-8479(96)90008-8

Setting: Clinical features of human immunodeficiency virus (HIV)-associated tuberculosis depend upon the patients' residual immunity. An immune-dependent presentation has also been described at the histopathological level in many extra-pulmonary sites, but no descriptions have so far been made on the histopathology of HIV-associated pulmonary tuberculosis. Objective: To compare the histopathological features of pulmonary tuberculosis in HIV-infected subjects and seronegative patients. Design: We carried out a retrospective comparative study on 16 HIV-infected subjects and 16 seronegative patients with culture-proven pulmonary tuberculosis who underwent transbronchial biopsy. We evaluated the bacillary burden and the parenchymal inflammatory reaction by means of a four-graded scoring system giving an approximate quantitative measure of the two parameters. Results: HIV-associated pulmonary tuberculosis was found to differ significantly from disease forms seen in seronegative patients, with a significant tendency to develop highly bacillary and poorly reactive histopathological pictures along with the downgrading evolution of immune function. Conclusion: Pathologic features of pulmonary tuberculosis in HIV-infected subjects differ from those encountered in seronegative patients depending upon the individual immunity of the former. HIV-associated progressive depletion of CD4+ lymphocytes leads to substantial changes in pulmonary reactivity to Mycobacterium tuberculosis; multibacillary pictures in a background of loose inflammatory reactions are quite common findings at the extreme phase of HIV-related immune deterioration. Cadre: Les caractéristiques cliniques de la tuberculose associée au VIH dépendent du degré d'immunité résiduelle des patients. L'immunodépendance de l'aspect lésionnel a également été décrite au niveau histopathologique dans de nombreux sites extrapulmonaires, mais jusqu'ici aucune description n'avait été faite de l'histopathologie de la tuberculose pulmonaire associée au VIH. Objectif: Comparer les caractéristiques histopathologiques de la tuberculose pulmonaire chez les sujets infectés par le VIH et les patients séronégatifs. Schéma: Nous avons conduit une étude comparative rétrospective sur 16 sujets infectés par le VIH et 16 patients séronégatifs qui tous avaient une tuberculose pulmonaire confirmée par la culture et avaient subi une biopsie transbronchique. Nous avons évalué la charge bacillaire et la réaction parenchymateuse inflammato