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Disseminated TB caused death in half of patients in sub-Saharan Africa
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Nearly half of all patients with Mycobacterium tuberculosis in sub-Saharan Africa may die within a month of hospitalization, despite access to treatment, researchers suggest.
“The clinical diagnosis of disseminated tuberculosis may be challenging in areas with limited laboratory services, as patients may present with nonspecific symptoms and signs and classic radiographic features of pulmonary or military tuberculosis may be absent,” the researchers from Duke University wrote. “Consequently, the diagnosis is often overlooked and is a frequent postmortem finding among HIV-infected patients in these areas with high rates of tuberculosis.”
The study was conducted in Moshi, Tanzania, where 508 participants were enrolled from March 10, 2006, to Aug. 28, 2010. Participants who had M. tuberculosis were followed for 1 year. The researchers evaluated survival, predictors of disseminated TB and predictors of death.
Of the participants, 29 had M. tuberculosis confirmed by blood culture. All of these participants also had HIV. The following characteristics were associated with bacteremic disseminated TB: cough lasting more than 1 month, fever lasting more than 1 month, weight loss of more than 10%, lymphadenopathy, HIV infection, lower CD4 count and lower total lymphocyte count.
Among the patients with bacteremic disseminated TB, 50% died within 36 days of study enrollment. Lower CD4 count and lower total lymphocyte count were associated with death from disseminated TB.
“Although almost one-half of participants with bacteremic disseminated tuberculosis had died by 1 month of follow-up, the fact that more than one-third of participants were still alive after 1 year is cause for some optimism,” the researchers wrote. “It is likely that earlier identification of patients with disseminated tuberculosis may increase the proportion of long-term survivors.”
References:
Crump JA. Clin Infect Dis. 2012;55:242-250.
Disclosures:
The researchers report no relevant financial disclosures.