TAILIEUCHUNG - Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults

Tuberculosis is a major public health problem globally as well as regionally. In Asia, the prevalence of HIV infection in TB patients has been lower than that reported from sub-Saharan Africa1. In urban areas in India, a series of referral center surveys from the late 1990’s reported an increasing prevalence of HIV among TB patients2-12 Raizada et al12 provided information from community based surveys on tuberculosis patients in different regions of India and showed a HIV prevalence varying from 1 to per cent in 15 different districts in India12. In India, more than 50 per cent of HIV seropositive. | Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults P Saranchuk A Boulle K Hilderbrand D Coetzee M Bedelu G van Cutsem G Meintjes Objectives. To evaluate the diagnostic accuracy of and reduction in diagnostic delay attributable to a clinical algorithm used for the diagnosis of smear-negative pulmonary tuberculosis SNPTB in HIV-infected adults. Design. An algorithm was designed to facilitate clinico-radiological diagnosis of pulmonary TB PTB in HIV-infected smear-negative adult patients. A folder review was performed on the first 58 cases referred for empirical TB treatment using this algorithm. Setting. Nolungile HIV Clinic Site C Khayelitsha. Subjects. Subjects included 58 HIV-infected adult patients with suspected PTB consecutively referred to the local TB clinic for outpatient TB treatment using this algorithm between 12 February 2004 and 30 April 2005. Outcome measures. Outcome measures were response of C-reactive protein haemoglobin weight and symptoms to TB treatment and TB culture result. Diagnostic delay in days was calculated. Results. Thirty-two of the 58 patients 55 had positive TB cultures definite TB . Initiation of TB treatment occurred on average days before the positive culture report. A further 21 patients 36 demonstrated clinical improvement on empirical treatment probable possible TB . Two patients did not improve and subsequently died without a definitive diagnosis. Three patients defaulted treatment. Conclusions. SNPTB is more common in HIV-infected patients and leads to diagnostic delay. This algorithm allowed for earlier initiation of TB treatment in HIV-infected patients presenting with symptoms of PTB and negative smears or nonproductive cough in a high TB incidence setting. S Afr Med J 2007 97 517-523. Tuberculosis TB is the commonest cause of morbidity and mortality in HIV-infected people in sub-Saharan The mortality associated with TB is considerably higher in HIV-infected .

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