title: Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: clinical, diagnostic and epidemiological characteristics.
abstract: In a setting with a high prevalence of HIV we studied (i) the prevalence of pulmonary tuberculosis (PTB) and HIV; (ii) clinical and epidemiological characteristics of PTB; and (iii) the usefulness of standard procedures for diagnosing PTB. Of 509 consecutive outpatients evaluated on clinical suspicion of PTB in Addis Ababa, 33.0% were culture-verified as having PTB. PTB patients, non-TB patients and controls were HIV-1-positive in 57.1%, 38.5% and 8.3% of cases, respectively. Predictors for culture-verified PTB were age < 25 y, male gender and the presence of HIV and fever, whereas profound weight loss indicated HIV infection. Diagnosis of PTB based on clinical symptoms, sputum microscopy for acid-fast bacilli and chest radiography was sensitive (86.7%) but unspecific (64.1%). In HIV-positive patients both sensitivity and specificity were significantly lower (p < 0.05). HIV-related pulmonary infections are often misinterpreted as smear-negative PTB. HIV screening is therefore warranted not only in cases of verified TB but also as part of the diagnostic work-up in patients with respiratory symptoms suggestive of PTB. Also, increased awareness of, and improved diagnostic tools for, HIV-related pulmonary infections other than PTB are required, together with algorithms for patients with suspected PTB.
authors.affiliation: Division of Infectious Diseases, Institution of Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. Judith.Bruchfeld@medhs.ki.se
authors.forename: Judith
authors.initials: J
authors.lastname: Bruchfeld
authors.forename: Getachew
authors.initials: G
authors.lastname: Aderaye
authors.forename: Ingela Berggren
authors.initials: IB
authors.lastname: Palme
authors.forename: Bjarne
authors.initials: B
authors.lastname: Bjorvatn
authors.forename: Sven
authors.initials: S
authors.lastname: Britton
authors.forename: Yewenhareg
authors.initials: Y
authors.lastname: Feleke
authors.forename: Gunilla
authors.initials: G
authors.lastname: Källenius
authors.forename: Lars
authors.initials: L
authors.lastname: Lindquist
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D003470:Culture Media; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D015995:Prevalence; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D003470:Culture Media