Case Report: Delayed Diagnosis of Opportunistic Infection from Mycobacterium Tuberculosis in Patients with Human Immunodeficiency Virus (HIV) Leads to Fatal Consequences
Background: HIV infection is a risk factor for TB, vice versa, TB infection accelerates the progressivity of HIV. WHO recommends the collaboration of HIV-TB to accelerate the diagnosis and treatment of TB and HIV while reducing the burden of society and government due to these diseases. TB and HIV infection is a serious health threat and could lead to fatal consequences if not treated properly.
Methods: A 32-year-old male patient, NR, was referred from a regional hospital with the diagnosis of HIV and was admitted to Labuang Baji Hospital, Makassar on 7 September 2020. He had a main complaint of fever a month before admission, accompanied by coughing, difficulty breathing, and diarrhea. He experienced a 17 kg weight loss within the last three months. There was no history of TB with unknown history of contact with TB patients. The patient received ARV treatment for the last three months. The results of laboratory tests were WBC 4,170/uL, HB 7.0 g/dl, PLT 305,000/uL, SGOT 238 IU/dl, SGPT 169 IU/dl, Albumin 2.09 g/dl, Anti-HIV (Rapid): Reactive (3 reagents), Thoracic radiograph: Active pulmonary TB, microscopic BTA +/+, molecular rapid test Xpert MTB/RIF: MTB detected low, rifampicin resistance not detected. The patient had a rapid clinical deterioration and died two days after diagnosed with TB.
Discussion: Opportunistic infection of TB in HIV patients increased along with the degree of severity of immune suppression due to decreased CD4 T lymphocytes as the main mediator of the body's immune defense. Therefore, HIV patients had a high risk of TB contraction or activation of dormant MTB from previous latent TB. The common clinical appearance of TB in HIV complicates the early diagnosis of TB in HIV patients. Delayed diagnosis of TB will worsen the immunity of HIV patients, thus accelerating death in patients with HIV-TB co-infection.
Conclusion: Delayed diagnosis and treatment of opportunistic infection of TB in HIV accelerate the death of HIV patients.
Keywords: Human Immunodeficiency Virus (HIV), Tuberculosis, Delayed Diagnosis
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