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Community Acquired Pneumonia and Tuberculosis: A Clinician's Dilemma

Lalloo, Umesh G. FCP, MD; Nyamande, Kennedy FCP, MD

Clinical Pulmonary Medicine: March 2010 - Volume 17 - Issue 2 - p 61-65
doi: 10.1097/CPM.0b013e3181d266d6
Respiratory Infections

The collision of the HIV epidemic with the tuberculosis (TB) epidemic in developing regions of the world has resulted in significant changes in the epidemiology of community acquired pneumonia (CAP). The clinician is frequently faced with the dilemma of when and whether to treat for TB in patients presenting with symptoms and signs of CAP who are coinfected with HIV. The issues include atypical presentation of TB and CAP in patients with AIDS, dual and even triple infections with TB frequently a common denominator, the lack of discrimination of duration of symptoms and signs of TB, development of immune reconstitution inflammatory response syndrome in patients receiving highly active antiretroviral treatment, and restricted access to investigations such as sputum induction, fiberoptic bronchoscopy, and limited access to laboratory tests (such as antigen and antibody microbiological tests and procalcitonin levels). The lack of a rapid diagnostic test for TB compounds the challenges.

An empiric approach to diagnosis and management of CAP is complicated in regions with high HIV prevalence and TB incidence. This review discusses the dilemmas facing clinicians in these settings.

From the Department of Pulmonology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

Address correspondence to: Umesh G. Lalloo, FCP, MD, Department of Pulmonology and Critical Care, University of KwaZulu Natal, Private Bag 7, Congella 4013, Durban South Africa. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.