Coinfection and clinical manifestations of tuberculosis in human immunodeficiency virus-infected and -uninfected adults at a teaching hospital, northwest Ethiopia
Afework Kassu, Getahun Mengistu, Belete Ayele, Ermias Diro, Firew Mekonnen, Dereje Ketema, Feleke Moges, Tsehay Mesfin, Assefa Getachew, Bahiru Ergicho, Daniel Elias, Abraham Aseffa, Yared Wondmikun, Fusao Ota
Department of Microbiology and Parasitology, University of Gondar, Gondar, Ethiopia; Department of Preventive Environment and Nutrition, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan; Department of Internal Medicine, Addis Ababa University, Addis Ababa; Departments of Internal Medicine, Community Health, Radiology, and Pathology, University of Gondar, Gondar; Armauer Hansen Research Institute, Addis Ababa; and Department of Physiology, University of Gondar, Gondar, Ethiopia
Received: January 10, 2006 Revised: April 3, 2006 Accepted: May 13, 2006
Background and purpose:
The pattern of clinical presentations of tuberculosis (TB) is reflected in the microbiological, radiological, and histological characteristics of the disease. However, coinfection with human immunodeficiency virus (HIV) poses special diagnostic and therapeutic challenges. This study was aimed at assessing the clinical manifestations of TB in patients with or without HIV coinfection in a hospital-based cross-sectional study in Gondar, Ethiopia.
TB was diagnosed following standard clinical, bacteriological, radiological, and histological procedures. HIV serostatus was checked by enzyme-linked immunosorbent assay.
This study included 257 TB patients, of whom 52.1% were coinfected with HIV. Pulmonary TB and extrapulmonary TB were diagnosed in 64.2% and 35.8% of the patients, respectively. No significant association was found between sputum smear positivity and HIV serostatus. One-fifth of the patients reported hemoptysis. More than one-third had chest pain, and >90% reported fever and weight loss. Night sweats and cough were reported by 86% and 82.5%, respectively. Coarse crepitations were the most frequent auscultatory finding (33.9%). Sputum smear positivity rate was 26.8%. Cavitation was significantly associated with sputum smear positivity (odds ratio = 9.0, 95% confidence interval = 2.4-34.1). Wasting, cough of ≤5 months' duration, crepitation, chronic diarrhea, and herpes zoster scar were significantly associated with HIV-positive serology.
Coinfection with HIV was very high in patients with TB. The presence of herpes zoster scar, chronic diarrhea, coarse crepitations, and cough of ≤5 months' duration may assist in identifying TB patients with HIV infection.
Comorbidity; Ethiopia; HIV; Tuberculosis
J Microbiol Immunol Infect. 2007;40:116-122.