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Abstract
Setting : Tuberculosis centre ofHôpital Jamot, Yaoundé, Cameroon.
Objective: - Identify simple clinical determinants associated with early death in hospitalized patients with new smear positive pulmonary tuberculosis (PTB).
Design: - A prospective cohort of 501 patients aged ≥ 15 years consecutively admitted from April 2009 to March 2010 was followed up in hospital during the 2-month intensive phase of treatment. On admission, patients were interviewed, their admission chest x-rays read and laboratory tests performed. Deaths occurring between admission and the end of the first 2 months of treatment were recorded as early deaths.
Results: - Of the 501patients with a mean age of 35.5 (range: 15-72) years, 59.1% were males and 160 (31.9%) were HIV positive. Twenty-one (4.2%, 95% CI: 2.4-5.9%) eventually died in hospital. Logistic regression analysis showed age ≥ 40 years (OR=3.64, 95% CI: 1.37- 9.67), HIV infection (OR=12.8, 95% CI: 2.74-59.46), anaemia (OR=3.64, 95% CI: 1.09-8.31) and hypoalbuminaemia (OR=3.18, 95% CI: 1.19-8.55) were independent predictors of early death.
Conclusion: Our results highlight the importance for the early detection and treatment of HIV infection in these patients. They also emphasize the need of measuring their serum albumin and haemoglobin levels in our environment as they are indicators of prognosis for which specific interventions could improve outcomes.
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References
- Médecins Sans Frontières. Running out of breath? TB care in the 21st century, Geneva, Switzerland: MSF, 2004.
- Harries AD. Issues facing TB control: tuberculosis control in sub-Saharan Africa in the face of HIV and AIDS. Scot Med J 45 (suppl 1) 47-50, 2000.
- Harries AD, Zachariah R, Lawn SD. Providing HIV care for coinfected tuberculosis patients: a perspective from sub-Saharan Africa. Int J Tuberc Lung Dis 13: 6-16, 2009.
- Connolly C, Davies GR, Wilkinson D. Impact of human immunodeficiency virus epidemic on mortality among adults with tuberculosis in rural South Africa. Int J Tuberc Lung Dis 2:919-925, 1998.
- Harries AD, Nyangulu DS, Kang’Ombe C, Ndalama D, Glynn JR, Banda H, Wirima JJ, Salaniponi FM, Liomba G, Maher D, Nunn P. Treatment outcome of an unselected cohort of tuberculosis patients in relation to human immunodeficiency virus serostatus in Zomba hospital, Malawi. Trans Roy Soc Trop Med Hyg 92:343-347, 1998.
- Zachariah R Spielmann MP, Harries AD, Salaniponi FML. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans Roy Soc Trop Med Hyg 96:291-294, 2002.
- Enarson DA, Rieder HL, Arnadottir T Trebucq A. Management of tuberculosis : a guide for low income countries. Fifth edition, Paris; International Union Againgst Tuberculosis and Lung Disease; 2000.
- Cameroon Ministry of Public Health. Comité National de Lutte contre le Sida. Circulaire N°D36-37/C/MSP/CAB du 13 août 2003.
- Guks CF, Brindle RJ, Otieno L S, Simani PM, Newnham RS, Bhatt SM, Lule GM, Okelo GB, Watkins WM, Waiyaki PG. Life threatening bacteriamia in HIV-1 seropositive adults admitted to hospital in Naïrobi, Kenya. Lancet 336: 545-549, 1990.
- Madebo T, Nysaeter G, Lindtjorn B. HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis. Scandinavian Journal of Infectious Disease 29:355-359, 1997.
- Niyongabo T, Henzel D, Idi M, Nimubona S, Gikoro E, Melchior JC, Matheron S, Kamanfu G, Samb B, Messing B, Begue J, Aubry P, Larouze B. Tuberculosis, human immunodeficiency virus infection and malnutrition in Burundi. Nutrition 15:229-293, 1999.
- Gordon MA, Walsh AL, Chaponda M, Soko D, Mbvwinji M, Molyneux ME, Gordon SB. Bacteremia and mortality among adult medical admissions in Malawi: predominance of non-typhi salmonellae and streptococcus pneumoniae. Journal of Infection 42:44-49, 2001.
- Teale C, Goldman JM, Pearson SB. The association of age with the presentation and outcome of tuberculosis: a five year survey. Age Ageing 22:289-293, 1993.
- Mehta JB, Fields CL, Byrd RP Jr. Roy TM. Nutritional status and mortality in respiratory failure caused by tuberculosis. Tenn Med 89:369-371, 1996.
- Matos ED, Moreira Lemos AC. Association between serum albumin levels and in-hospital deaths due to tuberculosis. Int J Tuberc Lung Dis 2006; 10:1360-1366.
- Sachs LV, Pendle S. Factors related to in-hospital deaths in patients with tuberculosis. Arch Intern Med 158:1916-1922, 1998.
- Walpola HC, Siskind L, Patel AM, Konstantenos A, Derhy P. Tuberculosis related deaths in Queensland Australia, 1989-1998. Characteristics and risk factors. Int J Tuberc Lung Dis 7:742-750, 2003.
- Whalen C, Horsburgh CR, Hom D Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med 151:129-135, 1995.
- Perneger TV, Sudre P, Lundgren JD, Hirschel B. Does the onset of tuberculosis in AIDS predict shorter survival? Results of a cohort study in 17 European countries over 13 years BMJ 311:1468-1471, 1995.
- Whalen C, Okwera A, Johnson JL, Vjecha M, Hom D, Wallis R, Huebner R, Mugerwa R, Ellner J. Predictors of survival in human immunodeficiency virus infected patients with pulmonary tuberculosis. Am J Respir Crit Care Med 10:153:1977-1981, 1996.
- Shafer RW, Bloch AB, Larkin C, Vasudavan V, Seligman S, Dehovitz JD, Di Ferdinando G, Stoneburner R, Cauthen G. Predictors of survival in HIV-infected tuberculosis patients. AIDS 10:269-272, 1996.
- Alpert PL, Mursiff SS, Gourevitch MN, Greenberg B, Klein RS. A prospective study of tuberculosis and human immunodeficiency virus infection: clinical manifestations and factors associated with survival. Clin Infect Dis 24:661-668, 1997.
- Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev 6:87-96, 2002.
- Baynes RD, Flax H, Bothwell TH, Bezwoda WR, Atkinson P, Mendelow B. Red blood cell distribution width in the anaemia secondary to tuberculosis. Am J Clin Pathol 85:226-229, 1986.
- Means RT Jr. Recent developments in the anaemia of chronic disease. Curr Hematol Rep 2:46-121, 2003.
- Weiss G, Goodnough LT. Anaemia of chronic disease N Engl J Med 2005; 352:1011-1023, 2005.
- Roberts PD, Hoffbrand AV, Mollin DL. Iron and folate metabolism in tuberculosis. BMJ 5507:198-202, 1966.
- Moyle G. Anaemia in persons with HIV infection: prognostic marker and contributor to morbidity. AIDS Rev 4:13-20, 2002.
- Adebisi SA, Olobuyo PO, Oladipo OO. The usefulness of serum albumin and urinary creatinine as biochemical indices for monitoring the nutritional status of Nigerians with pulmonary tuberculosis. Niger Postgrad Med J 10:247-250, 2003.
- Pablos-Mendez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 276:1223-1228, 1996.
- Edlin RR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, Ong KR, Kilburn JO, Dooley SW, Castro KG, Jarvis WR, Holmberg SD. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Eng J Med 326:1514-1521, 1992.
- Fischl MA, Ultamchandani RD, Daikos GL, Poblete RB, Moreno JN, Reyes RR, Boota AM, Thompson LM, Cleary TJ, Lai S. An outbreak of tuberculosis caused by multiple drug resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 117:177-183, 1992.
- Bercion R, Kuaban C. Resistance de Mycobacterium tuberculosis complex aux principaux antibacillaires à Yaoundé, Cameroun. Bull Soc Path Ex 91 :199-202, 1998.
References
Médecins Sans Frontières. Running out of breath? TB care in the 21st century, Geneva, Switzerland: MSF, 2004.
Harries AD. Issues facing TB control: tuberculosis control in sub-Saharan Africa in the face of HIV and AIDS. Scot Med J 45 (suppl 1) 47-50, 2000.
Harries AD, Zachariah R, Lawn SD. Providing HIV care for coinfected tuberculosis patients: a perspective from sub-Saharan Africa. Int J Tuberc Lung Dis 13: 6-16, 2009.
Connolly C, Davies GR, Wilkinson D. Impact of human immunodeficiency virus epidemic on mortality among adults with tuberculosis in rural South Africa. Int J Tuberc Lung Dis 2:919-925, 1998.
Harries AD, Nyangulu DS, Kang’Ombe C, Ndalama D, Glynn JR, Banda H, Wirima JJ, Salaniponi FM, Liomba G, Maher D, Nunn P. Treatment outcome of an unselected cohort of tuberculosis patients in relation to human immunodeficiency virus serostatus in Zomba hospital, Malawi. Trans Roy Soc Trop Med Hyg 92:343-347, 1998.
Zachariah R Spielmann MP, Harries AD, Salaniponi FML. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans Roy Soc Trop Med Hyg 96:291-294, 2002.
Enarson DA, Rieder HL, Arnadottir T Trebucq A. Management of tuberculosis : a guide for low income countries. Fifth edition, Paris; International Union Againgst Tuberculosis and Lung Disease; 2000.
Cameroon Ministry of Public Health. Comité National de Lutte contre le Sida. Circulaire N°D36-37/C/MSP/CAB du 13 août 2003.
Guks CF, Brindle RJ, Otieno L S, Simani PM, Newnham RS, Bhatt SM, Lule GM, Okelo GB, Watkins WM, Waiyaki PG. Life threatening bacteriamia in HIV-1 seropositive adults admitted to hospital in Naïrobi, Kenya. Lancet 336: 545-549, 1990.
Madebo T, Nysaeter G, Lindtjorn B. HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis. Scandinavian Journal of Infectious Disease 29:355-359, 1997.
Niyongabo T, Henzel D, Idi M, Nimubona S, Gikoro E, Melchior JC, Matheron S, Kamanfu G, Samb B, Messing B, Begue J, Aubry P, Larouze B. Tuberculosis, human immunodeficiency virus infection and malnutrition in Burundi. Nutrition 15:229-293, 1999.
Gordon MA, Walsh AL, Chaponda M, Soko D, Mbvwinji M, Molyneux ME, Gordon SB. Bacteremia and mortality among adult medical admissions in Malawi: predominance of non-typhi salmonellae and streptococcus pneumoniae. Journal of Infection 42:44-49, 2001.
Teale C, Goldman JM, Pearson SB. The association of age with the presentation and outcome of tuberculosis: a five year survey. Age Ageing 22:289-293, 1993.
Mehta JB, Fields CL, Byrd RP Jr. Roy TM. Nutritional status and mortality in respiratory failure caused by tuberculosis. Tenn Med 89:369-371, 1996.
Matos ED, Moreira Lemos AC. Association between serum albumin levels and in-hospital deaths due to tuberculosis. Int J Tuberc Lung Dis 2006; 10:1360-1366.
Sachs LV, Pendle S. Factors related to in-hospital deaths in patients with tuberculosis. Arch Intern Med 158:1916-1922, 1998.
Walpola HC, Siskind L, Patel AM, Konstantenos A, Derhy P. Tuberculosis related deaths in Queensland Australia, 1989-1998. Characteristics and risk factors. Int J Tuberc Lung Dis 7:742-750, 2003.
Whalen C, Horsburgh CR, Hom D Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med 151:129-135, 1995.
Perneger TV, Sudre P, Lundgren JD, Hirschel B. Does the onset of tuberculosis in AIDS predict shorter survival? Results of a cohort study in 17 European countries over 13 years BMJ 311:1468-1471, 1995.
Whalen C, Okwera A, Johnson JL, Vjecha M, Hom D, Wallis R, Huebner R, Mugerwa R, Ellner J. Predictors of survival in human immunodeficiency virus infected patients with pulmonary tuberculosis. Am J Respir Crit Care Med 10:153:1977-1981, 1996.
Shafer RW, Bloch AB, Larkin C, Vasudavan V, Seligman S, Dehovitz JD, Di Ferdinando G, Stoneburner R, Cauthen G. Predictors of survival in HIV-infected tuberculosis patients. AIDS 10:269-272, 1996.
Alpert PL, Mursiff SS, Gourevitch MN, Greenberg B, Klein RS. A prospective study of tuberculosis and human immunodeficiency virus infection: clinical manifestations and factors associated with survival. Clin Infect Dis 24:661-668, 1997.
Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev 6:87-96, 2002.
Baynes RD, Flax H, Bothwell TH, Bezwoda WR, Atkinson P, Mendelow B. Red blood cell distribution width in the anaemia secondary to tuberculosis. Am J Clin Pathol 85:226-229, 1986.
Means RT Jr. Recent developments in the anaemia of chronic disease. Curr Hematol Rep 2:46-121, 2003.
Weiss G, Goodnough LT. Anaemia of chronic disease N Engl J Med 2005; 352:1011-1023, 2005.
Roberts PD, Hoffbrand AV, Mollin DL. Iron and folate metabolism in tuberculosis. BMJ 5507:198-202, 1966.
Moyle G. Anaemia in persons with HIV infection: prognostic marker and contributor to morbidity. AIDS Rev 4:13-20, 2002.
Adebisi SA, Olobuyo PO, Oladipo OO. The usefulness of serum albumin and urinary creatinine as biochemical indices for monitoring the nutritional status of Nigerians with pulmonary tuberculosis. Niger Postgrad Med J 10:247-250, 2003.
Pablos-Mendez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 276:1223-1228, 1996.
Edlin RR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, Ong KR, Kilburn JO, Dooley SW, Castro KG, Jarvis WR, Holmberg SD. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Eng J Med 326:1514-1521, 1992.
Fischl MA, Ultamchandani RD, Daikos GL, Poblete RB, Moreno JN, Reyes RR, Boota AM, Thompson LM, Cleary TJ, Lai S. An outbreak of tuberculosis caused by multiple drug resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 117:177-183, 1992.
Bercion R, Kuaban C. Resistance de Mycobacterium tuberculosis complex aux principaux antibacillaires à Yaoundé, Cameroun. Bull Soc Path Ex 91 :199-202, 1998.