The bacteriology of pulmonary tuberculosis in a population with high human immunodeficiency virus seroprevalence
Abstract:Setting: A public sector urban university hospital in Soweto, South Africa.
Objective: To describe the utility of sputum smear microscopy and the prevalence of Mycobacterium tuberculosis resistance to antituberculosis drugs according to human immunodeficiency virus (HIV) serostatus in adults.
Design: A retrospective descriptive study of consecutive cases using a record review.
Results: We studied 412 adults with culture-proven pulmonary tuberculosis, of whom 185 (44.9%) were HIV-seropositive and had a significantly lower sputum smear positivity than HIV seronegatives (68% versus 79%, P < 0.05). Smear positivity was significantly higher in HIV-infected patients with CD4 counts ≤50/mm3 compared to those with CD4 counts of 201–300/mm3 (P < 0.05). In patients with and those without a history of previous treatment for tuberculosis, resistance to one or more antituberculosis drugs was found in 32.2% and 13.6% of cases, respectively, while resistance to both isoniazid and rifampicin (multidrug-resistant tuberculosis [MDR]) was found in 15.3% and 4.5% of patients, respectively. There was no significant difference in resistance between HIV-positive and seronegative patients.
Conclusion: A strong tuberculosis control programme and good surveillance will be required to prevent the further spread of MDR tuberculosis. Surveys such as these are useful for monitoring control programmes.
Document Type: Regular Paper
Affiliations: 1: Department of Medicine, Baragwanath Hospital, South Africa 2: Department of Microbiology, South African Institute for Medical Research and University of the Witwatersrand, Johannesburg, South Africa
Publication date: April 1, 1998
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