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Etiology of pulmonary infections in predominantly HIV-infected adults with suspected tuberculosis, Botswana

Authors: Lockman, S.1; Hone, N.2; Kenyon, T. A3; Mwasekaga, M.4; Villauthapillai, M.5; Creek, T.6; Zell, E.7; Kirby, A.7; Thacker, W. L.7; Talkington, D.7; Moura, I. N.8; Binkin, N. J.9; Clay, L.3; Tappero, J. W.10

Source: The International Journal of Tuberculosis and Lung Disease, Volume 7, Number 8, August 2003 , pp. 714-723(10)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

SETTING: In countries with high HIV rates, diagnosis of lower respiratory disease etiology is both challenging and clinically important.

OBJECTIVE: To determine the etiology of lower respiratory tract disease among persons with suspected tuberculosis (TB) and abnormal chest X-rays in a setting with very high HIV seroprevalence.

DESIGN: Cross-sectional prevalence data from a prospective cohort of predominantly hospitalized adults with suspected TB in Botswana, January–December 1997.

RESULTS: Of 229 patients, 86% were HIV-positive and 71% had a pathogen identified. TB was confirmed in 52%, 17% had acute mycoplasma pneumonia, 3% had Pneumocystis carinii, 27% grew a bacterial pathogen from sputum and 8% from blood. Ninety-four per cent of TB diagnoses were made through expectorated sputum and only 5% of TB cases were diagnosed by sputum induction alone. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis had positive and negative predictive values of 94% and 59%, respectively. Male sex, cough <2 weeks, and tuberculin skin test ≥5 mm were independently associated with culture-positive TB among persons with negative acid-fast bacilli smears. Co-infection with two or more pathogens occurred in 25%.

CONCLUSIONS: Mycoplasma pneumoniae infection was quite common despite clinical suspicion of TB, and sputum induction and PCR did not significantly improve our ability to diagnose TB, although clinical presentation had some predictive value.

Keywords: Botswana, Africa; HIV; Mycoplasma pneumoniae; respiratory disease diagnosis; smear-negative tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA; Centers for Disease Control and Prevention BOTUSA TB Project, Gaborone, Botswana; and the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Department of Medicine, Nyangabgwe Hospital, Francistown, Botswana 3: Centers for Disease Control and Prevention BOTUSA TB Project, Gaborone, Botswana 4: National TB Reference Laboratory, Gaborone, Botswana 5: Microbiology Section, National Health Laboratory, Gaborone, Botswana 6: Centers for Disease Control and Prevention BOTUSA TB Project, Gaborone, Botswana; and the Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 7: Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 8: Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 9: NCHSTP, DTBE, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 10: Centers for Disease Control and Prevention BOTUSA TB Project, Gaborone, Botswana; NCHSTP, DTBE, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and NCHSTP, HIV, Centers for Disease Control and Prevention, Bangkok, Thailand

Publication date: August 1, 2003

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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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