[Septicemia due to tuberculosis in HIV infection]

A 27-year old female HIV-positive patient developed septic tuberculosis, with mycobacterium tuberculosis typus humanus repeatedly found not only in sputum, bronchial secretion, blood and faeces but also in biopsy material from the liver. Although standard therapy with Pyrazinamid, Rifampicin and INH had to be replaced at times by Ethambutol or Streptomycin respectively, there was a surprisingly fast clinical and bacteriological improvement. Establishment of the diagnosis AIDS requires not only HIV-infection but also the occurrence of opportunistic infections. The latter include, according to the definition given by CDC, atypical mycobacteriosis, but not tuberculosis. Tuberculosis, however, is increasingly seen in HIV-infected patients. This observation allows us to question whether mycobacterium tuberculosis typus humanus should not be included in the list of opportunistic agents in AIDS. We conclude that in HIV infection the possibility of atypical and typical mycobacteriosis has to be taken into consideration. On the other hand, in tuberculosis patients at risk from AIDS the possibility of infection with HIV has to be considered. Tuberculin reactivity in HIV infected subjects is frequently missing and therefore can not be used for diagnosis. HIV-positive patients may require prophylactic treatment with INH, but BCG vaccination is strictly contraindicated. With early combination therapy continued for at least nine months, the prognosis may be good.