Persistent cough in patients using an urban chest clinic in Malawi.
In many sub-Saharan African countries, tuberculosis (TB) cases have been increasing steadily since 1985. In Malawi, they have increased by 38% from 1990 to 1993, and extrapulmonary TB increased by 79%. Among 385 patients with a history of persistent cough presumed to be TB, 360 (94%) initially consented to be tested for both HIV and TB. Of these, 301 completed testing and 95% returned for their test results. Among test completers (n = 301), 280 (93%) were found to be HIV-infected. Seropositivity rates were similar for males and females, and higher for urban dwellers than for rural dwellers (94% versus 79%). TB was found in only 48 (16%) patients. Among TB patients, 33 (77%) were HIV positive. This study suggests that TB may not be the main cause of persistent cough among persons using urban chest clinics in Malawi; HIV without sputum positive TB appears to be a major contributor. Clinicians in areas of high HIV prevalence should therefore suspect other HIV-related infections in a patient with persistent cough and in whom TB has been ruled out.
Nwanyanwu
O
O
Ministry of Health, Lilongwe, Malawi.
Nyangulu
D
D
Salaniponi
F
F
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000382:microbiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D008875:Middle Aged; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D014504:Urban Health