Martha Alemayehu1, Baye Gelaw2, Ebba Abate3, Liya Wassie4, Yeshambel Belyhun5, Shiferaw Bekele6, Russell R Kempker7, Henry M Blumberg8, Abraham Aseffa9. 1. Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia; Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia. Electronic address: marthialex2011@gmail.com. 2. Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia. Electronic address: tedybayegelaw@gmail.com. 3. Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia. Electronic address: ebbaabate@yahoo.com. 4. Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia. Electronic address: wassieliya@gmail.com. 5. Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia. Electronic address: belyhun@gmail.com. 6. Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia. Electronic address: shiferawbekele@gmail.com. 7. School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA 30303, USA. Electronic address: rkempke@emory.edu. 8. School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA 30303, USA. Electronic address: hblumbe@emory.edu. 9. Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia. Electronic address: aseffaa@gmail.com.
Abstract
BACKGROUND: Tuberculosis (TB) patients co-infected with human immunodeficiency virus (HIV) often lack the classic symptoms of pulmonary tuberculosis, making the diagnosis difficult. Current practices in resource-limited settings often indicate that these co-infected patients are diagnosed when they clinically manifest disease symptoms, resulting in a delayed diagnosis and despite continued transmission. The aim of this study is to determine the prevalence of undiagnosed pulmonary tuberculosis cases through active case finding and including multidrug-resistant TB (MDR-TB) among HIV-infected patients. MATERIALS AND METHODS: A total of 250 HIV-infected patients, aged 18years and above were evaluated in a cross-sectional design between February 2012 and November 2012. Socio-demographic and clinical data were collected using a structured questionnaire. Sputum samples were collected from all participants for acid fast bacilli (AFB) direct smear microscopy and Mycobacteria culture. A PCR-based RD9 deletion and genus typing, as well as first-line anti-TB drug susceptibility testing, was performed for all culture-positive isolates. RESULTS: Following active TB case finding, a total of 15/250 (6%) cases were diagnosed as TB cases, of whom 9/250 (3.6%) were detected by both smear microscopy and culture and the remaining 6/250 (2.4%) only by culture. All the 15 isolates were typed through RD9 typing of which 10 were Mycobacterium tuberculosis species; 1 belonged to Mycobacterium genus and 4 isolates were non-tuberculous mycobacteria. The prevalence of undiagnosed pulmonary TB disease among the study participants was 4.4%, which implies the possibility of identifying even more undiagnosed cases through active case finding. A multivariate logistic regression showed a statistically significant association between the presence of pneumonia infection and the occurrence of TB (OR=4.81, 95% CI (1.08-21.43), p=0.04). In addition, all the isolates were sensitive to all first-line anti-TB drugs, except for streptomycin, seen in only one newly diagnosed TB patient, and MDR-TB was not detected. CONCLUSION: The prevalence of undiagnosed pulmonary TB infection among HIV-infected patients in Gondar was 4.4%. Additionally, the possibility of these undiagnosed TB cases in the community could also pose a risk for the transmission of the disease, particularly among family members. Active screening of known HIV-infected individuals, with at least one TB symptom is recommended, even in persons with opportunistic infections.
BACKGROUND:Tuberculosis (TB) patients co-infected with human immunodeficiency virus (HIV) often lack the classic symptoms of pulmonary tuberculosis, making the diagnosis difficult. Current practices in resource-limited settings often indicate that these co-infected patients are diagnosed when they clinically manifest disease symptoms, resulting in a delayed diagnosis and despite continued transmission. The aim of this study is to determine the prevalence of undiagnosed pulmonary tuberculosis cases through active case finding and including multidrug-resistant TB (MDR-TB) among HIV-infectedpatients. MATERIALS AND METHODS: A total of 250 HIV-infectedpatients, aged 18years and above were evaluated in a cross-sectional design between February 2012 and November 2012. Socio-demographic and clinical data were collected using a structured questionnaire. Sputum samples were collected from all participants for acid fast bacilli (AFB) direct smear microscopy and Mycobacteria culture. A PCR-based RD9 deletion and genus typing, as well as first-line anti-TB drug susceptibility testing, was performed for all culture-positive isolates. RESULTS: Following active TB case finding, a total of 15/250 (6%) cases were diagnosed as TB cases, of whom 9/250 (3.6%) were detected by both smear microscopy and culture and the remaining 6/250 (2.4%) only by culture. All the 15 isolates were typed through RD9 typing of which 10 were Mycobacterium tuberculosis species; 1 belonged to Mycobacterium genus and 4 isolates were non-tuberculous mycobacteria. The prevalence of undiagnosed pulmonary TB disease among the study participants was 4.4%, which implies the possibility of identifying even more undiagnosed cases through active case finding. A multivariate logistic regression showed a statistically significant association between the presence of pneumonia infection and the occurrence of TB (OR=4.81, 95% CI (1.08-21.43), p=0.04). In addition, all the isolates were sensitive to all first-line anti-TB drugs, except for streptomycin, seen in only one newly diagnosed TB patient, and MDR-TB was not detected. CONCLUSION: The prevalence of undiagnosed pulmonary TB infection among HIV-infectedpatients in Gondar was 4.4%. Additionally, the possibility of these undiagnosed TB cases in the community could also pose a risk for the transmission of the disease, particularly among family members. Active screening of known HIV-infected individuals, with at least one TB symptom is recommended, even in persons with opportunistic infections.
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