The Relationship between Disease Pattern and Disease Burden by Chest Radiography, M. tuberculosis Load, and HIV Status in Patients with Pulmonary Tuberculosis in Addis Ababa

Aderaye, Getachew; Bruchfeld, Judith; Assefa, Getachew; Feleke, Daniel Getacher; Källenius, Gunilla; Baat, M; Lindquist, Lars

doi:10.1007/s15010-004-3089-x

Cited by 46 publications

(31 citation statements)

References 19 publications

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“…[34] Unfavourable outcomes in co-infected patients may be due to a delay in diagnosis because of atypical clinical presentation, and it is also known that co-infected patients tend to have paucibacillary TB or low microbacterial colony counts. [35] This reduction in microbacterial count makes the diagnosis of TB by smear microscopy more difficult.…”

Section: Researchmentioning

confidence: 99%

Influence of HIV and other risk factors on tuberculosis

Mahtab

Coetzee

2017

S Afr Med J

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Background. Tuberculosis (TB) notification in South Africa has increased six-fold over the past two decades, mainly because of the HIV epidemic. Objectives. To describe the sociodemographic and outcome characteristics of TB patients, and to identify risk factors associated with TB treatment outcomes stratified by HIV status. Methods. A cross-sectional study was used to analyse data from the Cape Town Metro East geographical service area (GSA) electronic TB register (ETR.Net), including adult patients aged ≥15 years who initiated TB treatment between 1 July 2011 and 30 June 2012. Results. TB case notification in the GSA was 922 per 100 000 population. Of the 12 672 TB patients registered, 50.5% were co-infected with HIV. The death rate in co-infected patients was 5.4% v. 2.8% in HIV-negative patients, the rate of treatment success 66.6% v. 73.5%, and the rate of unfavourable treatment outcome 28.1% v. 23.7%. The Khayelitsha subdistrict had the highest proportion of TB burden (37.0%) and co-infection (47.6%). Fourteen percent of patients had extrapulmonary TB, 65.9% of whom were co-infected with HIV. In the multivariate analysis, HIV infection (relative risk (RR) 1.2), retreatment (RR 1.4) and sputum smear microscopy not done (RR 1.4) were significantly associated with unfavourable treatment outcome. The Eastern (RR 0.9) and Northern (RR 0.7) subdistricts were less likely to have unfavourable outcomes compared with Khayelitsha. In the stratified analysis, retreatment and smear not done were significant risk factors for an unfavourable treatment outcome in both co-infected and HIV-negative patients. Conclusions. The burdens of both TB and co-infection were high in this community, although HIV prevalence varied. Mortality was higher and treatment completion lower in co-infected patients than in those who were HIV-negative. Co-infection, previous TB treatment and smear not done were significant risk factors for an unfavourable outcome in all patients.

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Section: Researchmentioning

confidence: 99%

Influence of HIV and other risk factors on tuberculosis

Mahtab

Coetzee

2017

S Afr Med J

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“…Wide variations have been observed on chest radiography among HIV patients. A study in Senegal has reported that such patients present with atypical chest radiographs, and could also present with normal or minimal chest lesions (Aderaye et al, 2004). The variability could be due to differing CD4 levels among these HIV TB co-infected patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the XpertMTB/RIF performance in active case detection among HIV positive TB patients has not been evaluated in Tanzania. The HIV infected patients tend to have atypical and/or asymptomatic TB leading to difficult and delayed diagnosis when using microscopy, and hence increased rates of morbidity and mortality (Aderaye et al, 2004). In this study, we evaluated the performance and effectiveness of XpertMTB/RIF, compared to microscopy, in TB detection among HIV positive patients using Lowenstein-Jensen culture as a gold standard.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Mollel

Chilongola

Mpagama

et al. 2016

Tanzania J Hlth Res

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Background: Diagnosis of tuberculosis (TB) in patients co-infected with HIV poses an important challenge because of the low sensitivity and specificity of microscopy, the standard diagnostic method. This study aimed to evaluate the performance of the XpertMTB/RIF tool for TB diagnosis among TB-HIV co-infected patients. Methods: This was a cross-sectional analytical study conducted at Kibong'oto Infectious Disease Hospital in northern Tanzania and involved 69 patients. The performance of the XpertMTB/RIF and microscopy using LJ culture were determined and compared. Demographic, clinical, laboratory and radiological data were collected. Results: XpertMTB/RIF had a higher sensitivity (100%), specificity (100%), positive predictive value (79.2%) and negative predictive value (98.9%) as compared to microscopy. There was a strong correlation between XpertMTB/RIF, microscopy and Löwenstein-Jensen (LJ) culture in terms of their sensitivity and specificity. Conclusion: While using TB symptoms screening tool alone in HIV infected individuals may result into overtreatment, relying on microscopy alone has the potential of TB under-diagnosing, miss-diagnosing and delayed treatment. Our results show XpertMTB/RIF to be highly sensitive and specific to detect all culture positive TB cases among HIV patients. We recommend the adoption of XpertMTB/RIF as an early TB diagnosis tool among HIV patients for early detection of TB among HIV patients.

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“…In the literature, the reported rates of normal chest X-rays in patients with smear-or culture-positive PTB are low, (4,11,13,22,24) except in HIV-infected patients. (8) A prevalence survey conducted in Cape Town, South Africa revealed that the presence of any abnormalities on chest X-ray has a high sensitivity for detecting subjects with smear-or culture-positive tuberculosis (0.97%; 95% CI: 0.90-1.00). (26) In our sample of 800 male patients, there was only one case of smear-or culture-positive tuberculosis and a normal chest X-ray.…”

Section: Discussionmentioning

confidence: 99%

“…The lesions are typically seen in the apical and posterior segments of the upper lobes, as well as in the superior segments of the inferior lobes. (2)(3)(4)(5)(6)(7)(8) However, in patients with HIV infection, diabetes, silicosis or malignancy, especially in females and in the elderly, the lower lung fields can be involved. (2,4,7,(9)(10)(11)(12)(13) Although sputum smear and culture are the main tools for the diagnosis and follow-up of PTB, clinicians frequently use chest X-ray in the differential diagnosis and the assessment of treatment responses.…”

Section: Introductionmentioning

confidence: 99%

Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar

et al. 2011

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Objective: To evaluate chest X-rays of patients with pulmonary tuberculosis and to determine whether the extent of radiographic lesions correlates with bacteriological parameters. Methods: In this retrospective, descriptive study, we evaluated chest X-rays, as well as AFB detection by smear microscopy and culture for Mycobacterium tuberculosis, initially and during the first two months of treatment, in 800 male patients hospitalized between 1995 and the present at a 250-bed hospital in northwestern Turkey. Results: The initial mean ESR was 58 ± 37 mm/h. Initial sputum smears and cultures were positive in 83.8% and 89.5% of the patients, respectively. After the first month of treatment, the proportion of patients with positive sputum culture was higher among those with cavitary tuberculosis than among those with non-cavitary tuberculosis (53.7% vs. 37.7%, p < 0.001). The number of affected zones was not correlated with age, symptom duration, contact with an active tuberculosis patient, or concomitant diabetes (p > 0.05 for all) but was positively correlated with the ESR (r = 0.23, p < 0.001). During the first and second months of treatment, conversion to smear-negative status was less common in patients with bilateral involvement than in those with unilateral involvement (p < 0.001 and p = 0.002 for months 1 and 2, respectively). Disease extent did not correlate with age, symptom duration, contact with an active tuberculosis patient, or concomitant diabetes but did correlate with delayed bacteriological recovery. Conclusions: Chest X-ray and bacteriology are valuable tools for the evaluation of pulmonary tuberculosis.Keywords: Radiography, thoracic; Bacteriology; Tuberculosis, pulmonary/drug therapy. ResumoObjetivo: Avaliar radiografias de tórax de pacientes com tuberculose pulmonar e determinar se a extensão das lesões radiográficas correlaciona-se com os parâmetros bacteriológicos. Métodos: Neste estudo descritivo e retrospectivo; foram avaliadas radiografias de tórax, baciloscopias para BAAR e culturas de escarro para Mycobacterium tuberculosis no momento basal e durante os dois primeiros meses de tratamento. A amostra foi composta por 800 pacientes masculinos internados entre 1995 até o presente em um hospital com 250 leitos no noroeste da Turquia. Resultados: A VHS média inicial foi de 58 ± 37 mm/h. Inicialmente, a baciloscopia e as culturas de escarro tiveram resultado positivo em 83,8% e em 89,5% dos pacientes, respectivamente. Após o primeiro mês do tratamento, a proporção de culturas positivas foi maior nos pacientes com doença cavitária do que naqueles sem doença cavitária (53,7% vs. 37,7%; p < 0,001). Não houve correlação do número de zonas afetadas com idade, duração de sintomas, contato com paciente com tuberculose ativa, diabetes concomitante (p > 0.05 para todos), mas houve correlação positiva com VHS (r = 0,23, p < 0,001). Durante o primeiro e o segundo mês de tratamento, a negativação da baciloscopia foi menos frequente nos pacientes com comprometimento bilateral do que naqueles com compr...

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The Relationship between Disease Pattern and Disease Burden by Chest Radiography, M. tuberculosis Load, and HIV Status in Patients with Pulmonary Tuberculosis in Addis Ababa

Cited by 46 publications

References 19 publications

Influence of HIV and other risk factors on tuberculosis

Influence of HIV and other risk factors on tuberculosis

Evaluation of XpertMTB/Rif performance for diagnosis of tuberculosis among HIV positive patients in northern Tanzania

Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar

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