Clinical picture and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with advanced HIV infection
Authors: Mishina A. V. , Mishin V. Yu. , Shashenkov I. V. 
Published: January 2025

Purpose

The aim of the study was to evaluate the features of clinic and diagnosis of comorbidity of pulmonary tuberculosis, coronavirus (CVP), pneumocystis (PCP) and pneumococcal (PCcP) pneumonia in patients in the late stages of HIV infection with immunodeficiency (ID).

Materials and methods

The prospective study included 120 newly diagnosed patients with disseminated pulmonary tuberculosis with isolation ofMycobacterium tuberculosisand IVB stage of HIV infection in the progression phase and in the absence of antiretroviral therapy aged 29-53 years, who were randomized into the main 1A and 2A groups and the 1B and 2B groups of comparison. The 1A group included 29 patients with comorbidity of disseminated pulmonary tuberculosis, coronavirus and pneumocystis pneumonia, in 2A - 31 patients with comorbidity of disseminated pulmonary tuberculosis, CVP and PCcP, while the 1B and 2B groups included 29 and 31 similar patients, but without CVP. PCR for SARS-CoV-2 RNA was used in naso- and oropharyngeal swabs, in sputum or in endotracheal aspirate to diagnose CVP. For the detection ofPneumocystis jirovecii, the causative agent of PCP, a microscopic examination of diagnostic material from the respiratory tract was carried out with staining according to Romanowsky-Giemsa and according to Grocott-Gomori, while for detection ofStreptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was sown on special nutrient media, with the determination of drug resistance of the obtained culture to broad-spectrum antibiotics. Statistical data processing was carried out using Microsoft Office Excel 2019 with calculation of mean value of the indicator in the group, standard error and confidence interval.

Results

The comorbidity of disseminated pulmonary tuberculosis, CVP, PCP and PCcP in patients in the late stages of HIV infection in the phase of progression and in the absence of antiretroviral therapy were characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms as well as also makes it difficult to visualize computed tomographic changes consisting of complex of simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous overlap of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a complex etiological diagnosis of the specific diseases to prescribe timely complex treatment and reduce mortality among that severe contingent of patients.

Conclusion

Patients with disseminated pulmonary tuberculosis and HIV infection represent a high-risk group for COVID-19 infection and development of CVP (and in in cases of severe immunodeficiency - PCP and PCcP) - they should be regularly subjected to preventive examinations for timely detection of COVID-19, CVP, PCP and PCcP and for purpose of their emergency hospitalization and timely treatment.