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Home / The International Journal of Tuberculosis and Lung Disease, Volume 5, Number 9

‘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: September 1, 2001

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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