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Free Content ‘Smear-negative’ pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence

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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.

Keywords: HIV; Malawi; mortality; outcome; smear-negative pulmonary tuberculosis

Document Type: Regular Paper

Affiliations: 1: National Tuberculosis Control Programme, Community Health Sciences Unit, Lilongwe, Malawi; Lilongwe Central Hospital, Lilongwe, Malawi; and Liverpool School of Tropical Medicine, Liverpool, UK 2: Lilongwe Central Hospital, Lilongwe, Malawi 3: Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, UK 4: National Tuberculosis Control Programme, Community Health Sciences Unit, Lilongwe, Malawi 5: Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: 2001-09-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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