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LETTER TO EDITOR
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 301

Tuberculous appendicitis: A rare case report


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication14-Sep-2016

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.190575

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How to cite this article:
Al-Mendalawi MD. Tuberculous appendicitis: A rare case report. CHRISMED J Health Res 2016;3:301

How to cite this URL:
Al-Mendalawi MD. Tuberculous appendicitis: A rare case report. CHRISMED J Health Res [serial online] 2016 [cited 2019 Oct 14];3:301. Available from: http://www.cjhr.org/text.asp?2016/3/4/301/190575

Sir,

I read with interest the case report by Pal et al. on the tuberculous appendicitis (TA).[1] Although the case in question presenting with acute abdomen was incidentally diagnosed to have primary TA on histopathological examination, I presume that concomitant human immunodeficiency virus (HIV) infection ought to be considered, and hence, CD4 count and viral overload measurements were solicited to be contemplated. My assumption is based on the following three points.

First, in India, HIV infection is still a major health threat. The recently published data pointed out that the estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35–0.47%). By 2010 and 2011, it leveled at estimates of 0.28% (0.24–0.34%) and 0.27% (0.22–0.33%), respectively.[2]

Second, the burden of HIV and tuberculosis (TB) coinfection is substantial in India. The available data pointed out to the prevalence of 12.3%.[3] Consequently, all TB patients were recommended to be assessed for HIV risk factors and counseled to undergo HIV testing, and conversely, all HIV-positive cases were recommended to be screened for TB.[3]

Third, the case in question was presented with a clinical picture highly suggestive of acute appendicitis, and the studied patient run an uneventful course after surgical intervention and initiation of anti-TB therapy. This, interestingly, contradicts the notion that HIV-associated TB has an atypical clinical, radiological, and biological presentation, as well as it tends to be more severe when there is significant immunosuppression.[4] This might be attributed to the interesting observation that CD4 count has been found not influencing the severity of TB in an Indian cohort with known HIV seropositivity.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Pal S, Bose K, Chowdhury M, Sikder M. Tuberculous appendicitis: A rare case report. CHRISMED J Health Res 2016;3:144-6.  Back to cited text no. 1
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2.
Raj Y, Sahu D, Pandey A, Venkatesh S, Reddy D, Bakkali T, et al. Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011. Int J STD AIDS 2015. pii: 0956462415612650.  Back to cited text no. 2
    
3.
Manjareeka M, Nanda S. Prevalence of HIV infection among tuberculosis patients in Eastern India. J Infect Public Health 2013;6:358-62.  Back to cited text no. 3
[PUBMED]    
4.
Kouassi B, N'Gom A, Horo K, Godé C, Ahui B, Emvoudou NM, et al. Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. Rev Mal Respir 2013;30:549-54.  Back to cited text no. 4
    
5.
Naha K, Dasari S, Prabhu M. HIV-tuberculosis co-infection in an Indian scenario: The role of associated evidence of immunosuppression. Asian Pac J Trop Med 2013;6:320-4.  Back to cited text no. 5
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