Demographic and Clinicoradiological Presentation of Tuberculosis in Patients with Sickle Cell Haemoglobinopathy: A Cross-sectional Study

Abstract

Introduction: Infectious disease is an important contributor to disability and death in Sickle Cell Haemoglobinopathy (SCH). India has a high burden of Tuberculosis (TB) and SCH is widespread among residents in and around Burla, Odisha. This was the first attempt to find the prevalence of SCH in active cases of TB in Indian adults. Aim: To estimate the prevalence of SCH in TB and to evaluate the demographic and clinicoradiological presentation of TB in patients with SCH in a subset of Indian population. Materials and Methods: A cross-sectional study was conducted from October 2010 to September 2012 in Department of Pulmonary Medicine of VSSMC, Burla, Odisha, India. The primary inclusion criterion was patients with TB and SCH. Demographic characteristics, clinical, radiological, microbiological and histopathology data were collected. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) 18.0. Association between categorical data was calculated using Chi-square test and Fisher’s exact test. A p-value of <0.05 was considered to be significant. Results: Out of 1243 TB patients who were screened, 64 TB patients had SCH. The mean age of the patients were 30.41±13.48 years with female predominance 33 (51.56%). The prevalence of SCH in TB was 51.49/1000, Sickle Cell Anaemia (SCA) was 13.68/1000 and Sickle Cell Trait (SCT) was 37.81/1000. Total 47 (73.43%) patients had SCT and 17 (26.56%) patients had SCA. Majority of patients with SCA 15 (88.23%) and SCT 35 (74.46%) belonged to the age of ≤40 years. Total 38 (59.37%) patients had Pulmonary TB (PTB) and 26 (40.62%) had Extrapulmonary TB (EPTB). EPTB 11 (64.70%) was common in patients with SCA than PTB 6 (35.29%) and vice-versa in SCT 15 (31.91% vs 32 (68.08%) (p=0.018). Among PTB patients, cough was the most common symptom seen in 7 (10.93%) patients of SCA and in 26 (40.62%) patients of SCT. The mean (±SD) haemoglobin in patients with SCA was 7.270 (±2.007) gm% and SCT was 9.021 (±1.578) gm% (p-value=0.002). The most common chest radiographic finding was nodules in patients with SCA 9 (52.94%), reticular opacities and pleural effusion 11 (23.40%) each in SCT. Conclusion: In the present study, 5.14% of TB patients had SCH. Pulmonary TB (PTB) was more common than EPTB in patients with SCH.

Keywords

• anaemia
• extrapulmonary
• montoux test
• pulmonary tuberculosis
• sickle cell haemoglobinopathy