Extra-pulmonary and smear-negative forms of tuberculosis are associated with treatment delay and hospitalisation

• Published in: The international journal of tuberculosis and lung disease Vol. 14; no. 6; pp. 741 - 744
• Main Authors: WHITEHORN, J, AYLES, H, GODFREY-FAUSSETT, P
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.06.2010; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Cross-Sectional Studies; Delay; Diagnosis; Female; Follow-Up Studies; HIV; Hospitalization; Human bacterial diseases; Human immunodeficiency virus; Humans; Incidence; Infectious diseases; Male; Medical sciences; Mycobacterium; Mycobacterium tuberculosis - isolation & purification; Pneumology; Prognosis; Prospective Studies; Respiratory system : syndromes and miscellaneous diseases; Sputum - microbiology; Time Factors; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis - microbiology; Tuberculosis - therapy; Tuberculosis and atypical mycobacterial infections; Zambia; Zambia - epidemiology; Zambia; Africa; Respiratory disease; Lung; Retroviridae; Zambia; Mycobacterial infection; Lentivirus; Infection; Virus; Treatment; Tuberculosis; delay; HIV; Bacteriosis; Smear; Diagnosis; Human immunodeficiency virus; Pneumology
• ISSN: 1027-3719; 1815-7920

SETTING: Adult patients with tuberculosis (TB) recruited at the chest clinic of the University Teaching Hospital in Lusaka, Zambia, from 2003 to 2004.OBJECTIVE: To identify factors associated with delayed treatment or hospitalisation.DESIGN: A cross-sectional survey of newly identified adult patients with TB.RESULTS: A total of 223 patients were included in the analysis. Patients with smear-negative disease were 2.6 times more likely to be hospitalised than those with smear-positive disease (95%CI 1.28-5.30), while patients with extra-pulmonary disease were 3.42 times more likely to be hospitalised than those with pulmonary disease (95%CI 1.75-6.66). Patients with smear-negative disease were 2.81 times more likely to have experienced overall delay than those with smear-positive disease (95%CI 1.20-6.66).DISCUSSION: This analysis has demonstrated that patients with extra-pulmonary or smear-negative disease are significantly more likely to be hospitalised. Patients with smear-negative disease are also more likely to have experienced treatment delay. These data reinforce the urgent need for more robust diagnostic tests, particularly for smear-negative and extra-pulmonary disease. As these forms of disease are more likely to be associated with the human immunodeficiency virus (HIV), the data support earlier diagnosis and treatment of HIV infection.