Mortality in smear-negative tuberculosis patients in Phalombe

Area of Science:

• Global Health
• Infectious Diseases
• Pulmonology

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in regions with high Human Immunodeficiency Virus (HIV) prevalence.
• Smear-negative pulmonary tuberculosis (PTB) presents diagnostic difficulties and is associated with poorer outcomes.
• Malawi faces a dual epidemic of HIV and TB, with 80-90% HIV prevalence among TB patients.

Purpose of the Study:

• To determine the treatment outcomes for patients with smear-negative pulmonary tuberculosis in Malawi.
• To investigate the relationship between chest x-ray (CXR) findings, laboratory parameters, and mortality in this patient group.

Main Methods:

• Retrospective analysis of 70 patients registered with smear-negative PTB across two Malawian hospitals.
• Evaluation of treatment outcomes, including mortality rates.
• Correlation of outcomes with CXR findings and white cell count.

Main Results:

• A high mortality rate of 46% (32 out of 70 patients) was recorded.
• Mortality was significantly higher in patients with normal or minimally abnormal CXR findings (62%).
• Patients with a white cell count below 3.5 × 10^9/L experienced a 77% mortality rate.

Conclusions:

• Smear-negative pulmonary tuberculosis in high HIV prevalence settings is associated with extremely poor treatment outcomes.
• Normal chest x-ray findings and low white cell counts are indicators of particularly high mortality risk.
• Further research is crucial to understand the underlying reasons for this high mortality and to develop targeted interventions.