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A systemic review of tuberculosis with HIV coinfection in children

Abstract

The epidemiology of tuberculosis is adversely impacted by the human immunodeficiency virus (HIV) coinfection. HIV-infected patients are more prone to opportunistic infections, most commonly tuberculosis, and the risk of death in coinfected patients is higher than in those without HIV. Due to the impaired cellular immunity and reduced immunological response in HIV-infected patients, the classic imaging features of tuberculosis usually seen in patients without HIV may present differently. The aim of this review article is to highlight the imaging features that may assist in the diagnosis of tuberculosis in patients with HIV coinfection.

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References

  1. 1.

    Nelson C, Zunt J (2011) Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis 53:915–926

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Berenguer J, Moreno S, Laguna F et al (1992) Tuberculous meningitis in patients infected with the human immunodeficiency virus. N Engl J Med 326:668–672

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    World Health Organization Tuberculosis (2016) www.who./int/mediacentre/factsheet/fs104/en-WHO/Tuberculosis. Accessed Jan 2017

  4. 4.

    Zar HJ (2008) Chronic lung disease in human immunodeficiency virus (HIV) infected children. Pediatr Pulmonol 43:1–10

    Article  PubMed  Google Scholar 

  5. 5.

    Zampoli M, Kilborn T, Eley B et al (2007) Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children. Int J Tuberc Lung Dis 11:417–423

    CAS  PubMed  Google Scholar 

  6. 6.

    George R, Andronikou S, Theron S et al (2009) Pulmonary infections in HIV-positive children. Pediatr Radiol 39:545–554

    Article  PubMed  Google Scholar 

  7. 7.

    Du Toit G, Swingler G, Iloni K et al (2002) Observer variation in detecting lymphadenopathy on chest radiography. Int J Tuberc Lung Dis 6:814–817

    CAS  PubMed  Google Scholar 

  8. 8.

    Zar HJ (2007) Diagnosis of pulmonary tuberculosis in children-what's new? S Afr Med J 97:983–985

    PubMed  Google Scholar 

  9. 9.

    Andronikou S, van der Merwe DJ, Goussard P et al (2012) Usefulness of lateral radiographs for detecting tuberculous lymphadenopathy in children- confirmation using sagittal CT reconstruction with multiplanar cross-referencing. SA J Radiol 16:87–92

    Google Scholar 

  10. 10.

    South African National Department of Health (2010) Guidelines for the management of HIV in children, 2nd edn

  11. 11.

    Donald PR (2002) Childhood tuberculosis: out of control? Curr Opin Pulm Med 8:178–182

    Article  PubMed  Google Scholar 

  12. 12.

    South African National Department of Health (2010) New EPI Vaccine Guidelines. https://www.health-e.org.za/wp-content/uploads/2014/02/South-Africa-EPI-vaccines-revised-Oct-2010.pdf. Accessed 20 Oct 2016

  13. 13.

    World Health Organization AIDS epidemic update UNAIDS/09.36E/JC1700E 2009 372 November 2009. http://data.unaids.org/pub/report/2009/jc1700_epi_update_2009_en.pdf. Accessed 20 Oct 2016

  14. 14.

    Andronikou S, Joseph E, Lucas S et al (2004) CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children. Pediatr Radiol 34:232–236

    Article  PubMed  Google Scholar 

  15. 15.

    Leung AN, Muller NL, Pineda PR et al (1992) Primary tuberculosis in childhood: radiographic manifestations. Radiology 182:87–91

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Mahomed N, Hleza B, Andronikou S et al (2011) The doughnut sign. SA J Child Health 5:2

    Google Scholar 

  17. 17.

    Andronikou S, Brauer B, Galpin J et al (2005) Interobserver variability in the detection of mediastinal and hilar lymph nodes on CT in children with suspected pulmonary tuberculosis. Pediatr Radiol 235:425–428

    Article  Google Scholar 

  18. 18.

    Andronikou S, Wieselthaler N (2004) Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis. Pediatr Radiol 34:861–875

    Article  PubMed  Google Scholar 

  19. 19.

    Lucas S, Andronikou S, Goussard P et al (2012) CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities. Pediatr Radiol 42:923–931

    Article  PubMed  Google Scholar 

  20. 20.

    Andronikou S, Wieselthlaler N (2009) Imaging for tuberculosis in children. In: Schaaf HS (ed) Tuberculosis: A comprehensive clinical reference. Saunders Elsevier, p 36

  21. 21.

    Moseme T, Andronikou S (2014) Through the eye of the suprasternal notch: point-of-care sonography for tuberculous mediastinal lymphadenopathy in children. Pediatr Radiol 44:681–684

    Article  PubMed  Google Scholar 

  22. 22.

    Bosch-Marcet J, Serres-Creixams X, Borras-Perez V et al (2007) Value of sonography for follow-up of mediastinal lymphadenopathy in children with tuberculosis. J Clin Ultrasound 35:118–124

    Article  PubMed  Google Scholar 

  23. 23.

    Lin YS, Huang YC, Lin TY et al (2010) Abdominal tuberculosis in children: Diagnostic imaging. J Microbiol Immunol Infect 43:88–193

    Google Scholar 

  24. 24.

    Venturini E, Turkova A, Chiappini E et al (2014) Tuberculosis and HIV co-infection in children. BMC Infect Dis 14:1471–2234

    Google Scholar 

  25. 25.

    Andronikou S, Welman CJ, Kader E et al (2002) The CT features of abdominal tuberculosis in children. Pediatr Radiol 32:75–81

    Article  PubMed  Google Scholar 

  26. 26.

    Shao H, Yang Z, Deng W et al (2012) Tuberculosis versus lymphoma in the abdominal lymph nodes: a comparative study using contrast enhanced MRI. Eur J Radiol 81:2513–2517

    Article  PubMed  Google Scholar 

  27. 27.

    Jamieson DH (1995) Imaging intracranial tuberculosis in childhood. Pediatr Radiol 25:165–170

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Dekker G, Andronikou S, van Toorn R et al (2011) MRI findings in children with tuberculous meningitis: comparison of HIV-infected and non-infected patients. Childs Nerv Syst 27:1943–1949

    Article  PubMed  Google Scholar 

  29. 29.

    Madhi S, Huebner R, Doedens L et al (2000) HIV-1 co-infection in children hospitalised with tuberculosis in South Africa. Int J Tuberc Lung Dis 4:448–454

    CAS  PubMed  Google Scholar 

  30. 30.

    Andronikou S, Govender N, Ramdass A et al (2012) MRI appearances of tuberculous meningitis in HIV-infected children – a paradoxically protective mechanism at play? Imaging Med 4:359–366

    CAS  Article  Google Scholar 

  31. 31.

    Janse van Rensburg P, Andronikou S, van Toorn R et al (2008) Magnetic resonance imaging of miliary tuberculosis of the central nervous system in children with tuberculous meningitis. Pediatr Radiol 38:1306–1313

    Article  PubMed  Google Scholar 

  32. 32.

    Whiteman M, Espinoza L, Post MJ et al (1995) Central nervous system tuberculosis in HIV-infected patients: clinical and radiographic findings. AJNR Am J Neuroradiol 16:1319–1327

    CAS  PubMed  Google Scholar 

  33. 33.

    Anuradha HK, Garg RK, Sinha MK et al (2011) Intracranial tuberculomas in patients with tuberculous meningitis: predictors and prognostic significance. Int J Tuberc Lung Dis 15:234–239

    CAS  PubMed  Google Scholar 

  34. 34.

    Garg RK, Malhotra HS, Jain A et al (2016) Neuroimaging in tuberculous meningitis. Neurol India 64:219–227

    Article  PubMed  Google Scholar 

  35. 35.

    Garg RK, Sinha MK (2011) Tuberculous meningitis in patients infected with human immunodeficiency virus. J Neurol 258:3–13

    Article  PubMed  Google Scholar 

  36. 36.

    Kamra P, Azad R, Prasad KN et al (2004) Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 77:387–394

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    van Toorn R, Schaaf HS, Solomons R et al (2014) The value of transcranial Doppler imaging in children with tuberculous meningitis. Childs Nerv Syst 30:1711–1716

    Article  PubMed  Google Scholar 

  38. 38.

    Katrak SM, Shembalkar PK, Bijwe SR et al (2000) The clinical, radiological and pathological profile of tuberculous meningitis in patients with and without human immunodeficiency virus infection. J Neurol Sci 181:118–126

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Andronikou S, Binderpasad M, Govender N et al (2011) Musculoskeletal tuberculosis – imaging using low-end and advanced modalities for developing and developed countries. Acta Radiol 52:430–441

    Article  PubMed  Google Scholar 

  40. 40.

    Dunn R (2010) The medical management of spinal tuberculosis. SA Orthop J 9:37–41. Available at: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1681-150X2010000100007&lng=en. Accessed 14 Sept 2015

  41. 41.

    Shah M, Jhaveri S, Tuli S et al (2011) Musculoskeletal tuberculosis in children. Surgery in Africa–monthly review. Available at: https://ptolemy.library.utoronto.ca/sites/default/files/reviews/2011/May%20-%20Musculoskeletal%20Tuberculosis%20in%20Children.pdf. Accessed 14 Sept 2015

  42. 42.

    Theron S, Andronikou S, George R et al (2009) Non-infective pulmonary disease in HIV-positive children. Pediatr Radiol 39:555–564

    Article  PubMed  Google Scholar 

  43. 43.

    Kilborn T, Zampoli M (2009) Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children. Pediatr Radiol 39:569–574

    Article  PubMed  Google Scholar 

  44. 44.

    Van Rie A, Sawry S, Link-Gelles R et al (2016) Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in children. Pediatr Pulmonol 51:157–164

    Article  PubMed  Google Scholar 

  45. 45.

    Smith K, Kuhn L, Coovadia A et al (2009) Immune reconstitution inflammatory syndrome among HIV-infected South African infants initiating antiretroviral therapy. AIDS 23:1097–1107

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Rabie H, Violari A, Duong T et al (2011) Early antiretroviral treatment reduces risk of bacille Calmette-Guerin immune reconstitution adenitis. Int J Tuberc Lung Dis 15:1194–1200 i

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Link-Gelles R, Moultrie H, Sawry S et al (2014) Tuberculosis immune reconstitution inflammatory syndrome in children initiating antiretroviral therapy for HIV infection: a systematic literature review. Pediatr Infect Dis J 33:499–503

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Rajeswaran G, Becker JL, Michailidis C et al (2006) The radiology of IRIS in patients with mycobacterial tuberculosis and HIV co–infection: appearances in 11 patients. Clin Radiol 61:833–843

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Marais S, Scholtz P, Pepper DJ et al (2010) Neuroradiological features of the tuberculosis-associated immune reconstitution inflammatory syndrome. Int J Tuberc Lung Dis 14:188–196

    CAS  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Van Toorn R, Rabie H, Dramawski A et al (2012) Neurological manifestations of TB-IRIS: a report of 4 children. Eur J Paediatr Neurol 16:676–682

    Article  PubMed  Google Scholar 

  51. 51.

    Lawn SD, Bekker LG, Miller RF et al (2005) Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis 5:361–373

    Article  PubMed  Google Scholar 

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Correspondence to Jaishree Naidoo.

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Naidoo, J., Mahomed, N. & Moodley, H. A systemic review of tuberculosis with HIV coinfection in children. Pediatr Radiol 47, 1269–1276 (2017). https://doi.org/10.1007/s00247-017-3895-9

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Keywords

  • Children
  • Diagnosis
  • Diagnostic imaging
  • Human immunodeficiency virus
  • Immunity
  • Opportunistic infection
  • Tuberculosis