title: Evaluation of the burden of unsuspected pulmonary tuberculosis and co-morbidity with non-communicable diseases in sputum producing adult inpatients.
abstract: BACKGROUND
  A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with non-communicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.
  
  
  RESULTS
  In this prospective study, newly admitted adult inpatients able to produce sputum at the University Teaching Hospital, Lusaka, Zambia, were screened for pulmonary TB using fluorescent smear microscopy and automated liquid culture. The burden of pulmonary TB, unsuspected TB, TB co-morbidity with NCDs and CDs was determined. Sputum was analysed from 900 inpatients (70.6% HIV infected) 277 (30.8%) non-TB suspects, 286 (31.8%) TB suspects and 337 (37.4%) were already receiving TB treatment. 202/900 (22.4%) of patients had culture confirmed TB. TB co-morbidity was detected in 20/275 (7.3%) NCD patients, significantly associated with diabetes (P = 0.006, OR 6.571, 95%CI: 1.706-25.3). 27/202 (13.4%) TB cases were unsuspected. There were 18 confirmed cases of MDR-TB, 5 of which were unsuspected.
  
  
  CONCLUSIONS
  A large burden of unsuspected pulmonary TB co-morbidity exists in inpatients with NCDs and other CDs. Pro-active sputum screening of all inpatients in tertiary referral centres in high TB endemic countries is recommended. The scale of the problem of undiagnosed MDR-TB in inpatients requires further study.
authors: Division of Infection and Immunity, Department of Infection, University College London, London, United Kingdom.
authors: Matthew
authors: M
authors: Bates
authors: Justin
authors: J
authors: O'Grady
authors: Peter
authors: P
authors: Mwaba
authors: Lophina
authors: L
authors: Chilukutu
authors: Judith
authors: J
authors: Mzyece
authors: Busiku
authors: B
authors: Cheelo
authors: Moses
authors: M
authors: Chilufya
authors: Lukundo
authors: L
authors: Mukonda
authors: Maxwell
authors: M
authors: Mumba
authors: John
authors: J
authors: Tembo
authors: Mumba
authors: M
authors: Chomba
authors: Nathan
authors: N
authors: Kapata
authors: Andrea
authors: A
authors: Rachow
authors: Petra
authors: P
authors: Clowes
authors: Markus
authors: M
authors: Maeurer
authors: Michael
authors: M
authors: Hoelscher
authors: Alimuddin
authors: A
authors: Zumla
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology*; D062606:Tertiary Care Centers; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000382:microbiology / Q000401:mortality*