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.
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-TBpatients 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 TBpatients 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-TBpatients being mistakenly treated for TB.
Authors: Philippe Glaziou; Katherine Floyd; Eline L Korenromp; Charalambos Sismanidis; Ana L Bierrenbach; Brian G Williams; Rifat Atun; Mario Raviglione Journal: Bull World Health Organ Date: 2011-05-31 Impact factor: 9.408
Authors: Karen R Steingart; Megan Henry; Suman Laal; Philip C Hopewell; Andrew Ramsay; Dick Menzies; Jane Cunningham; Karin Weldingh; Madhukar Pai Journal: Thorax Date: 2007-08-03 Impact factor: 9.139
Authors: David W Dowdy; Richard E Chaisson; Gary Maartens; Elizabeth L Corbett; Susan E Dorman Journal: Proc Natl Acad Sci U S A Date: 2008-08-11 Impact factor: 11.205
Authors: Winceslaus Katagira; Nicholas D Walter; Saskia Den Boon; Nelson Kalema; Irene Ayakaka; Eric Vittinghoff; William Worodria; Adithya Cattamanchi; Laurence Huang; John Lucian Davis Journal: J Acquir Immune Defic Syndr Date: 2016-07-01 Impact factor: 3.731
Authors: Karen R Steingart; Megan Henry; Suman Laal; Philip C Hopewell; Andrew Ramsay; Dick Menzies; Jane Cunningham; Karin Weldingh; Madhukar Pai Journal: Postgrad Med J Date: 2007-11 Impact factor: 2.401
Authors: D J Bell; R Dacombe; S M Graham; A Hicks; D Cohen; T Chikaonda; N French; M E Molyneux; E E Zijlstra; S B Squire; S B Gordon Journal: Int J Tuberc Lung Dis Date: 2009-01 Impact factor: 2.373
Authors: Peter Daley; Joy Sarojini Michael; Kalaiselvan S; Asha Latha; Dilip Mathai; K R John; Madhukar Pai Journal: PLoS One Date: 2009-05-20 Impact factor: 3.240