title: Chronic cough in primary health care attendees, Harare, Zimbabwe: diagnosis and impact of HIV infection.
abstract: BACKGROUND
  Cough lasting for > or = 3 weeks (i.e., chronic cough) indicates that a patient has suspected tuberculosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  A total of 544 adults with chronic cough were recruited systematically from 2 primary health care clinics, and they were evaluated using preset first- and second-line investigations and diagnostic case definitions.
  
  
  RESULTS
  The overall prevalence of HIV infection among the study cohort was 83%. TB was the most common diagnosis, with 207 HIV-positive patients (46%) and 27 HIV-negative patients (30%) having confirmed or probable TB. Of these, 145 HIV-positive patients with TB (70%) and 20 HIV-negative patients with TB (74%) had smear-positive cases of TB. Only 17 HIV-positive and 2 HIV-negative patients had smear-negative but culture-positive cases of TB. Lower respiratory tract infections (n = 178; HIV prevalence, 79%) and pneumonia (n = 87; HIV prevalence, 89%) were the next most common diagnoses. Asthma (n = 26; HIV prevalence, 46%), posttuberculous disease and other fibrotic lung disease (n = 34; HIV prevalence, 88%), and cardiac disease (n = 15; HIV prevalence, 93%) were more common than were Pneumocystis jiroveci pneumonia and cryptococcosis (n = 8 and n = 5, respectively; HIV prevalence, 100%), and we found no cases of nocardiosis or histoplasmosis.
  
  
  CONCLUSIONS
  TB was diagnosed for 43% of patients who presented with chronic cough to primary health care clinics in Harare, with 71% having smear-positive disease. The findings of TB culture added relatively little to the findings of fluorescent microscopy of concentrated sputum specimens. The prevalence of HIV infection was high across a range of diagnoses, suggesting that an HIV test should be recommended in the initial investigation of chronic cough.
authors.affiliation: National Institute of Health Research, Harare, Zimbabwe.
authors.forename: Shungu S
authors.initials: SS
authors.lastname: Munyati
authors.forename: Temba
authors.initials: T
authors.lastname: Dhoba
authors.forename: Evelyn D
authors.initials: ED
authors.lastname: Makanza
authors.forename: Stanley
authors.initials: S
authors.lastname: Mungofa
authors.forename: Maureen
authors.initials: M
authors.lastname: Wellington
authors.forename: Junior
authors.initials: J
authors.lastname: Mutsvangwa
authors.forename: Lovemore
authors.initials: L
authors.lastname: Gwanzura
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Morgan
authors.initials: M
authors.lastname: Nyakabau
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mason
authors.forename: Valerie
authors.initials: V
authors.lastname: Robertson
authors.forename: Simba
authors.initials: S
authors.lastname: Rusakaniko
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Butterworth
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Corbett
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015030:Zimbabwe / Q000453:epidemiology