'Smear-negative' pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence


Hargreaves, NJ; Kadzakumanja, O; Whitty, CJM; Salaniponi, FML; Harries, AD; Squire, SB; (2001) 'Smear-negative' pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence. The international journal of tuberculosis and lung disease, 5 (9). pp. 847-54. ISSN 1027-3719

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Abstract

SETTING: Lilongwe Central Hospital, Malawi. OBJECTIVES: To investigate 1) treatment outcome of a cohort of smear-negative pulmonary TB (snPTB) patients in an area of high human immunodeficiency virus (HIV) seroprevalence, and 2) whether poor treatment outcomes are due to non-TB patients being mistakenly treated for TB due to lack of diagnostic facilities. DESIGN: Patients about to be registered for snPTB treatment by the National TB Programme underwent further assessment including TB culture, bronchoscopy and bronchoalveolar lavage. All patients were followed up for 8 months. Standard TB control treatment outcomes were recorded. RESULTS: Of 352 snPTB patients assessed, 137 patients had bacteriologically confirmed TB, 136 had possible TB, and 79 had other non-TB diagnoses. The HIV seroprevalence rate was 89%. Outcomes were known for 325 (92%) patients: 129 (40%) died within 8 months. Death rates on TB treatment were 31% for bacteriologically confirmed TB patients and 35% for patients with possible TB but no bacteriological diagnosis. The death rate among patients with non-TB diagnoses was 53%. HIV infection significantly increased the risk of death (OR 3.9; P = 0.01). CONCLUSION: SnPTB is strongly associated with HIV infection in Malawi, where patients treated for snPTB have a poor prognosis. The high mortality is not fully explained by non-TB patients being mistakenly treated for TB.

Item Type: Article
Keywords: mortality, smear-negative pulmonary tuberculosis, outcome, Malawi, HIV, Human-immunodeficiency-virus, malawi, nairobi, kenya, malabsorption, bacteremia, infection, morbidity, mortality, blantyre, Adolescent, Adult, Aged, Aged, 80 and over, Antitubercular Agents, therapeutic use, Bronchoscopy, Cause of Death, Cohort Studies, Directly Observed Therapy, False Positive Reactions, Female, HIV Seroprevalence, Human, Malawi, Male, Middle Age, Mycobacterium tuberculosis, isolation & purification, Odds Ratio, Prognosis, Sputum, microbiology, Support, Non-U.S. Gov't, Treatment Outcome, Tuberculosis, Pulmonary, diagnosis, drug therapy, mortality
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 11573897
Web of Science ID: 170809800010
URI: http://researchonline.lshtm.ac.uk/id/eprint/17533

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