Evaluation of the Burden of Unsuspected Pulmonary Tuberculosis and Co-Morbidity with Non-Communicable Diseases in Sputum Producing Adult Inpatients

Abstract

BackgroundA high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with non-communicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.Methodology/Principal FindingsIn this prospective study, newly admitted adult inpatients able to produce sputum at the University Teaching Hospital, Lusaka, Zambia, were screened for pulmonary TB using fluorescent smear microscopy and automated liquid culture. The burden of pulmonary TB, unsuspected TB, TB co-morbidity with NCDs and CDs was determined. Sputum was analysed from 900 inpatients (70.6% HIV infected) 277 (30.8%) non-TB suspects, 286 (31.8%) TB suspects and 337 (37.4%) were already receiving TB treatment. 202/900 (22.4%) of patients had culture confirmed TB. TB co-morbidity was detected in 20/275 (7.3%) NCD patients, significantly associated with diabetes (P = 0.006, OR 6.571, 95%CI: 1.706–25.3). 27/202 (13.4%) TB cases were unsuspected. There were 18 confirmed cases of MDR-TB, 5 of which were unsuspected.Conclusions/SignificanceA large burden of unsuspected pulmonary TB co-morbidity exists in inpatients with NCDs and other CDs. Pro-active sputum screening of all inpatients in tertiary referral centres in high TB endemic countries is recommended. The scale of the problem of undiagnosed MDR-TB in inpatients requires further study.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…461,462 464 Following the widely publicised and high-mortality outbreak of XDR tuberculosis at the Church of Scotland Hospital in KwaZulu-Natal, South Africa, a series of similar targeted interventions have dramatically reduced transmission in the hospital and in the community.…”

Tuberculosis: A Literature Review

“…The persons which any one of four symptoms weight loss, night sweats a cough and fever is strongly recommended for tuberculosis screening. Tuberculosis proactive screening is highly recommended in areas where the disease is highly spatial, since tuberculosis patients with noncommunicable diseases or HIV infection (example; tobaccorelated chronic lung disease and diabetes mellitus and) may be missed 24,25 .…”

‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World

“…Pakistan reported ten times higher prevalence of DM in TB patients compared to normal population 12 . In Zambia, another country with a very high TB burden (462/100,000 population), it was found that TB comorbidity was significantly associated with DM (OR = 6.5, 95% CI 1.7-25.3) 13,14 . Conversingly, in countries with a low TB burden such as Australia (5.8/100,000), TB risk in diabetic patients was increased only moderately (adjusted relative risk RR = 1.48, 95% CI 1.04-2.10) 15 .…”