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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania
Clinical Infectious Diseases, Volume 40, No. 10, Year 2005
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Description
Background. We sought to determine the prevalence of active tuberculosis among ambulatory HIV-infected persons in Tanzania with CD4 cell counts of ≥200 cells/mm3 and a bacille Calmette-Guérin vaccination scar. Methods. Subjects who volunteered for a tuberculosis booster vaccine trial were screened for active tuberculosis by obtainment of a history, physical examination, chest radiography, sputum culture and acid fast bacillus (AFB) stain, and blood culture. All subjects underwent a tuberculin skin test (TST) and lymphocyte proliferation assays (LPAs) for detection of responses to mycobacterial antigens. Results. Active tuberculosis was identified at baseline in 14 (15%) of the first 93 subjects who were enrolled: 10 (71%) had clinical tuberculosis (symptoms or chest radiograph findings), and 4 (29%) had subclinical tuberculosis (positive sputum AFB stain or culture results but no symptoms or chest radiograph findings). An additional 6 subjects with subclinical tuberculosis were identified subsequently. The 10 subjects with subclinical tuberculosis included 3 with positive sputum AFB stains results and 7 who were only identified by a positive sputum culture result. Compared with subjects who did not have tuberculosis, the 10 subjects with subclinical tuberculosis were more likely to have peripheral lymphadenopathy, positive TST results, and elevated LPA responses to early secreted antigenic target-6 (ESAT). Eight of 10 patients had received isoniazid because of a positive TST result before active tuberculosis was recognized. Conclusions. Clinical and subclinical tuberculosis are common among ambulatory HIV-infected persons, and some cases can only be identified by sputum culture. World Health Organization guidelines for screening for latent tuberculosis before treatment do not recommend sputum culture and, therefore, may fail to identify a substantial number of HIV-infected persons with subclinical, active tuberculosis. © 2005 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Mtei, Lillian N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Matee, Mecky Isaac N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Herfort, Oliver
United States, Lebanon
Dartmouth-hitchcock Medical Center
Bakari, Muhammad
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Horsburgh, Charles Robert
United States, Boston
Boston University
Waddell, R.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Cole, Bernard F.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Vuola, Jenni M.
Finland, Helsinki
Terveyden ja Hyvinvoinnin Laitos
Finland, Espoo
Glaxosmithkline oy
Tvaroha, Susan
United States, Lebanon
Dartmouth-hitchcock Medical Center
Kreiswirth, Barry N.
United States, Newark
Public Health Research Institute
Pallangyo, Kisali J.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Fordham Von Reyn, C.
United States, Lebanon
Dartmouth-hitchcock Medical Center
Statistics
Citations: 207
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1086/429825
ISSN:
10584838
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Tanzania