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Infection and morbidity in patients with tuberculosis in Nairobi, Kenya
R J Brindle1, P P Nunn, B I Batchelor
1Kenya Medical Research Institute, Nairobi.
Objective:
To examine the role of acute infection as a cause of morbidity in patients with tuberculosis.
Design:
Cross-sectional documentation of predefined acute morbid events.
Setting:
Infectious Diseases Hospital, Nairobi, Kenya.
Patients:
Adults (> or = 15 years), inpatients and outpatients with a diagnosis of tuberculosis presenting with one or more of a series of clinical features. A new event was defined as one occurring at least 1 week after the initial event.
Interventions:
Patients' treatment was modified depending on the results of laboratory investigations.
Main Outcome Measures:
There were 642 events from 398 patients, 235 HIV-positive patients had 438 events and 163 HIV-negative patients had 204 events (P < 0.0001). Forty-two out of the 235 (18%) HIV-positive patients were bacteraemic compared with nine out of the 163 (6%) HIV-negative patients (P = 0.0003). The most common isolates from blood were Salmonella typhimurium and Streptococcus pneumoniae.
Results:
Faecal specimens were obtained more commonly from HIV-positive patients (P < 0.001), and often contained bacterial pathogens.
Conclusions:
Many of the causes of morbidity in patients with tuberculosis and HIV are not due to tuberculosis or antituberculous therapy, and will not be identified without microbiological investigation.