The Burden and Clinical Presentation of Pulmonary Tuberculosis in Adults With Severe Respiratory Illness in a High Human Immunodeficiency Virus Prevalence Setting, 2012–2014

Details

• Alternative Title:
  Open Forum Infect Dis
• Personal Author:
  Walaza, Sibongile ; Tempia, Stefano ; Dreyer, Andries ; Dawood, Halima ; Variava, Ebrahim ; Martinson, Neil A. ; Moyes, Jocelyn ; Cohen, Adam L. ; Wolter, Nicole ; von Mollendorf, Claire ; von Gottberg, Anne ; Haffejee, Sumayya ; Treurnicht, Florette ; Hellferscee, Orienka ; Ismail, Nazir ; Cohen, Cheryl
• Description:
  Background
  
  Understanding the burden and clinical presentation of tuberculosis in patients with severe respiratory illness (SRI) has important implications for anticipating treatment requirements.
  
  Methods
  
  Hospitalized patients aged ≥15 years with SRI at 2 public teaching hospitals in periurban areas in 2 provinces (Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province and Tshepong Hospital in Klerksdorp, North West Province) were enrolled prospectively from 2012 to 2014. Tuberculosis testing included smear microscopy, culture, or Xpert MTB/Rif.
  
  Results
  
  We enrolled 2486 individuals with SRI. Of these, 2097 (84%) were tested for tuberculosis, 593 (28%) were positive. Tuberculosis detection rate was 18% (133 of 729) in individuals with acute (≤14 days) presentation and 34% (460 of 1368) in those with chronic (>14 days) presentation. Among laboratory-confirmed tuberculosis cases, those with acute presentation were less likely to present with cough (88% [117 of 133] vs 97% [447 of 460]; ajusted odds ratio [aOR] = 0.2, 95% confidence interval [CI] = 0.1–0.5), night sweats (57% [75 of 132] vs 73% [337 of 459]; aOR = 0.4, 95% CI = 0.3–0.7), or be started on tuberculosis treatment on admission (63% [78 of 124] vs 81% [344 of 423]; aOR = 0.4, 95% CI = 0.3–0.7), but they were more likely to be coinfected with pneumococcus (13% [16 of 124] vs 6% [26 of 411]; aOR 2.3, 95% CI 1.3–5.3) than patients with chronic presentation. Annual incidence of acute and chronic tuberculosis-associated SRI per 100000 population was 28 (95% CI = 22–39) and 116 (95% CI = 104–128), respectively.
  
  Conclusions
  
  In this setting, tuberculosis, including acute presentation, is common in patients hospitalized with SRI.
  
  
• Subjects:
  HIV Infections Tuberculosis, Multidrug-Resistant Tuberculosis, Pulmonary
• Source:
  Open Forum Infect Dis. 2017; 4(3).
• Pubmed ID:
  28852676
• Pubmed Central ID:
  PMC5570023
• Document Type:
  Journal Article
• Funding:
  U51 IP000155/IP/NCIRD CDC HHS/United States
• Place as Subject:
  South Africa
• Volume:
  4
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d6df02f7dba75177b5838bbffc8796aba3df2d514d0fbebbf26b3ecf41c59d13
• Download URL:
  https://stacks.cdc.gov/view/cdc/47837/cdc_47837_DS1.pdf
• File Type:
  [PDF - 267.86 KB ]