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Clinical Manifestations of HIV-Associated Tuberculosis in Adults

  • Sean WassermanEmail author
  • David Barr
  • Graeme Meintjes
Chapter

Abstract

HIV-associated tuberculosis is a heterogenous disease that confronts clinicians with substantial diagnostic challenge. Clinical syndromes are frequently non-specific in terms of symptoms, physical examination, routine laboratory testing, and chest radiography. Further complicating management is the possibility of co-infection with other severe opportunistic infections, all of which may have clinical presentations that mimic tuberculosis. Early recognition and treatment is urgent because of more severe manifestations and rapid progression, particularly at low CD4 counts. This chapter describes clinical manifestations and diagnostic approaches for HIV-associated tuberculosis in adults, with an emphasis on practice in resource-limited, high-burden settings. Advanced immunosuppression and disseminated disease are considered separately from ambulant patients with preserved CD4 cell counts in order to highlight differences in clinical phenotype, differential diagnosis, and management strategies. Clinical features and evaluation of common extra-pulmonary manifestations are also covered.

Keywords

HIV-associated tuberculosis Mycobacteraemia Disseminated tuberculosis Extra-pulmonary tuberculosis Lipoarabinomannan GeneXpert Rapid diagnostics 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of MedicineUniversity of Cape TownCape TownSouth Africa
  2. 2.Division of Infectious Diseases and HIV Medicine, Department of MedicineUniversity of Cape TownCape TownSouth Africa
  3. 3.Institute of Infection and Global Health, University of LiverpoolLiverpoolUK

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