|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 4 | Page : 301
Tuberculous appendicitis: A rare case report
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq
|Date of Web Publication||14-Sep-2016|
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Mendalawi MD. Tuberculous appendicitis: A rare case report. CHRISMED J Health Res 2016;3:301
I read with interest the case report by Pal et al. on the tuberculous appendicitis (TA). 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.
Second, the burden of HIV and tuberculosis (TB) coinfection is substantial in India. The available data pointed out to the prevalence of 12.3%. 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.
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. 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.
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Conflicts of interest
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| References|| |
Pal S, Bose K, Chowdhury M, Sikder M. Tuberculous appendicitis: A rare case report. CHRISMED J Health Res 2016;3:144-6.
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