Improving diagnosis of pulmonary tuberculosis among HIV/AIDS patients: literature review and experience in a teaching hospital in Indonesia.

Acta Med Indones. 2009 Jul;41 Suppl 1:57-64

Authors: Rewata L, Rutherford M, Apriani L, Janssen W, Rahmadi A, Parwati I, Yuwono A, van Crevel R

HIV infection hampers diagnosis of pulmonary tuberculosis (PTB) because many pathogens cause pulmonary infection in HIV people and the load of Mycobacterium tuberculosis is lower in HIV patients. We conducted a literature review and prospectively examined clinical, radiological, and laboratory diagnosis of PTB in 71 HIV-patients (29 inpatients and 42 outpatients) in a teaching hospital in West Java, Indonesia. For both in- and outpatients, signs and symptoms were sensitive but not specific for PTB. Chest X-ray (CXR) was sensitive but less specific. Among hospitalized PTB suspects, 28,8% could not expectorate sputum. Compared to culture, ZN had a sensitivity of 11.1% and 66.7% for in- and outpatients, respectively. From the literature, fluorescence microscopy, liquid culture, and nucleic acid assays can improve diagnosis of PTB in HIV, while IFNg-release assays lack sensitivity, especially in advanced HIV. The current practice of using CXR and microscopy lacks sensitivity for diagnosing PTB in HIV patients. Sputum culture is more sensitive but slow. Fluorescence microscopy might be a quick, relatively sensitive and feasible option in Indonesia. However, because of the frequent absence of sputum, especially in patients with advanced HIV-AIDS patients, there is an urgent need for alternative diagnostic methods using blood or urine.

PMID: 19920300 [PubMed - indexed for MEDLINE]

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Clostridium difficile infection in the elderly.

Acta Med Indones. 2009 Jul;41(3):148-51

Authors: Taslim H

The aging society and the advanced of supportive treatment means that large numbers of elderly patients with risk factors for C difficile enterocolitis will continue to receive care in intensive care unit. Antibiotic resistance and older, sicker patients means that combination antibiotic therapy will become a trend in clinical setting. Age, several co-morbidities, and gastrointestinal surgery appear to be specific risk factors for C difficile infection. Diarrhea which is the only symptom in hospitalized patient should drive us to rethink about the possibility of C difficile infection especially in the elderly patient. Prudent use of antibiotic, infection control are strategies to prevent C difficile infection in clinical setting. Elderly patients who undergo gastrointestinal surgery have an increased rate of C difficile infection because of commonly used nasogastric tube. Gastrointestinal surgical patients typically have preoperative bowel preparation, receive oral preoperative antibiotics that are poorly absorbed, impaired bowel motility secondary to ileus, receive systemic preoperative antibiotics prophylaxis, and have variable lengths of no oral caloric intake during the preoperative period. The continued imprudent use of prolonged postoperative systemic antibiotics for presumed preventive purposes, particularly among the elderly and patients who have nasogastric tubes or other enteric tubes, appears to be a recipe for preventable infections with C difficile.

PMID: 19752488 [PubMed - indexed for MEDLINE]

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