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LETTER TO EDITOR
Year : 2021  |  Volume : 14  |  Issue : 4  |  Page : 208

Tuberculous splenic abscess in non-human immunodeficiency virus patient


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

Date of Submission26-Jun-2021
Date of Decision10-Aug-2021
Date of Acceptance20-Sep-2021
Date of Web Publication11-Jan-2022

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
P.O.Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hmj.hmj_36_21

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How to cite this article:
Al-Mendalawi MD. Tuberculous splenic abscess in non-human immunodeficiency virus patient. Hamdan Med J 2021;14:208

How to cite this URL:
Al-Mendalawi MD. Tuberculous splenic abscess in non-human immunodeficiency virus patient. Hamdan Med J [serial online] 2021 [cited 2022 Jan 20];14:208. Available from: http://www.hamdanjournal.org/text.asp?2021/14/4/208/335380



Dear Editor,

I read with interest the case report by Juneja and Jhamb[1] published in the April-June 2021 issue of the Hamdan Medical Journal. They reported a case of tuberculous splenic abscess in a non-human immunodeficiency virus (HIV) female patient, aged 22 years, from India. It is well-known that due to a compromised immune status, HIV-infected patients are venerable to different types of infections, including tuberculosis (TB). Extrapulmonary TB is not uncommon among such patients. Interestingly, splenic lesions were detected with ultrasonography in 21% of HIV-positive patients and TB diagnosed by smear, biopsy, culture or molecular methods was reported to be the cause of 88.3% of splenic microabscesses found on ultrasonography in such patients.[2] India is among Asian countries importantly affected by HIV and TB infections. The available data pointed out that among TB patients in India, 12% were HIV-positive, and of these, 40% were newly diagnosed.[3] Claiming the immunocompetent status in the case in question based on the negative enzyme-linked immunosorbent assay (ELIZA) as Juneja and Jhamb[1] stated is questionable. The 4th-generation combining HIV antibody and p24 antigen test could better detect early HIV infection. It has a sensitivity and specificity of 100% and 97.8%, respectively.[4] I presume that TB should be considered seriously in the studied patient. Juneja and Jhamb[1] ought to in-depth evaluate the HIV status in their studied patient by employing a more advanced diagnostic tool such as the above-mentioned test rather than solely relying upon ELIZA. Documenting HIV positivity in the case in question would make it the second case report of HIV-associated TB splenic abscess in the Indian literature. The first case was reported in a 40-year-old female.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Juneja A, Jhamb R. Tuberculous splenic abscess in non-human immunodeficiency virus patient. Hamdan Med J 2021;14:104-5.  Back to cited text no. 1
  [Full text]  
2.
Schafer JM, Welwarth J, Novack V, Balk D, Beals T, Naraghi L, et al. Detection of splenic microabscesses with ultrasound as a marker for extrapulmonary tuberculosis in patients with HIV: A systematic review. S Afr Med J 2019;109:570-6.  Back to cited text no. 2
    
3.
Kumar AM, Gupta D, Kumar A, Gupta RS, Kanchar A, Rao R, et al. HIV testing among patients with presumptive tuberculosis: How do we implement in a routine programmatic setting? Results of a large operational research from India. PLoS One 2016;11:e0156487.  Back to cited text no. 3
    
4.
Han H, Huang Y, Dong Q, Huang Y, Lu J, Wang W, et al. Clinical application evaluation of a fourth-generation HIV antigen antibody combination screening assay. Clin Lab 2019;65. [doi: 10.7754/Clin.Lab. 2019.190220].  Back to cited text no. 4
    
5.
Jadhav SV, Vyawahare CR, Chaudhari N, Gupta NS, Gandham NR, Misra RN. Primary splenic tubercular abscess in an immunocompromised patient-rapid diagnosis by line probe assay. J Clin Diagn Res 2013;7:1996-8.  Back to cited text no. 5
    




 

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