Paradoxical response during anti-tuberculosis treatment in HIV-negative patients with pulmonary tuberculosis.

BACKGROUND

Transient worsening of tuberculosis (TB) symptoms and lesions following anti-tuberculosis treatment (paradoxical response [PR]), has been described in human immunodeficiency virus (HIV) infected patients who undergo anti-tuberculosis treatment. The frequency and clinical presentations for PR in HIV-negative patients with pulmonary TB are unknown.

OBJECTIVE

To determine the incidence of PR and its associated manifestations in a retrospective study of HIV-negative patients with pulmonary TB.

RESULTS

Of 659 TB patients, 16 developed PR, with an incidence of 2.4%. The medium onset time of PR was 26 days. Recurrent fever was the most common clinical manifestation. Compared with 643 patients without PR, patients developing PR had significantly decreased haemoglobin, albumin, body mass index and baseline lymphocyte counts. There was a noticeable increase in the lymphocyte count during paradoxical deterioration in PR subjects than in the control group. Independent factors for developing PR included anaemia, hypoalbuminaemia, lymphopaenia and lymphocyte count increase during PR development.

CONCLUSIONS

The clinical manifestations of PR in patients with pulmonary TB were different from those in patients with extra-pulmonary TB. Baseline anaemia, hypoalbuminaemia, lymphopaenia and a greater change in lymphocyte count were independent risk factors for developing PR.