CUTANEOUS HYPERSENSITIVITY REACTIONS IN TUBERCULOSIS PATIENTS

ON STREPTOMYCIN(S) THIACETAZONE(T) AND ISONIAZID(H) IN MULAGO
HOSPITAL

BY

DR. MUGALA FLAVIA M.B ChB (MUK)

THIS DISSERTATION IS SUBMITTED AS A PARTIAL FULFILLMENT FOR THE REQUIREMENT OF THE DEGREE OF MASTER OF MEDICINE (INTERNAL MEDICINE) IN THE FACULTY OF MEDICINE, MAKERERE UNIVERSITY 1991)

Supervisor: Dr. E. Katabira M.B Ch.B (MU) M.R.C.P

Head of Department of Medicine: Associate Prof. R. Mugerwa M.B Ch.B (MUK), M.Med (MUK)

ABSTRACT

The incidence of Tuberculosis is rising in developing countries in association with the high incidence of Human Immuno-Deficiency virus Infection. Though the response to anti-tuberculosis therapy has been favorable in AIDS patients, several studies have noted an increase in drug reactions in AIDS patients on anti tuberculosis therapy. A 20% incidence of cutaneous hypersensitivity reactions in patients on STH are shown from a neighboring country to Uganda. However, most reports of similar findings in Uganda have been anecdotal and some findings have been conflicting, in that one study of pulmonary tuberculosis in HIV positive patients showed no significant increase in cutaneous side effects in patients on STH as compared to a Rifampcin containing regimen.

To determine the incidence of cutaneous hypersensitivity reactions in HIV positive patients and HIV negative patients on standard anti T.B drugs in Mulago, 122 patients with tuberculosis, 72 of whom were HIV positive and 50 were HIV negative, were prospectively followed for 8 weeks. HIV positive patients were more likely to have extra pulmonary tuberculosis with or without pulmonary tuberculosis, negative mantoux test, pleural effusion, or radiological findings of multilobar involvement, low lymphocyte counts, and low haemoglobin levels, than HIV negative patients.

Severe cutaneous hypersensitivity reactions (CHR) occurred in 16.6% of HIV positive patients and 6% HIV of negative patients. (RR 2.42, confidence Interval, HIV negative (0.83 <RR <7.04). These results are statistically significant. There was no significant difference in the incidence of mild and moderate cutaneous skin reactions in HIV positive and HIV negative patients. However, HIV positive patients with an AIDS defining illness were more likely to develop a severe CHR than asymptomatic HIV positive patients (RR = 6.13 confidence interval 1.95<RR<1927 P<0.05). Mortality in the HIV positive group was 1.3% and in the HIV positive group was 0%. By the end of six weeks 91.6% of cutaneous reactions had occurred in HIV positive patients and 100% had occurred in HIV negative patients.

Conclusion: Cutaneous hypersensitivity reactions are a significant cause of morbidity in HIV positive patients on STH and also contribute to the mortality associated with AIDs in patients who also have tuberculosis. These reactions are more frequent in patients with an AIDS defining illness, but further objective studies are necessary to confirm these findings.

KEYWORDS[ AIDS, tuberculosis, seroprevalence ]