Abstract
Objectives: To determine the aetiology of pulmonary disease in HAART-naïve, HIV-infected Zambian adults with severe immunosuppression
Design: A cross-section study.
Setting: University Teaching Hospital, Lusaka, Zambia.
Subjects: We conducted intensive TB screening for HAART-naïve HIV-infected patients with CD4+ count less than 200/μL with pulmonary symptoms. Our algorithm comprised initial sputum screening with ZN stain. Patients unable to expectorate sputum and those in whom sputum smear for TB was negative underwent bronchoscopy. BAL was assessed for causative agents and correlated with clinical and radiological findings.
Results: Of 113 enrolled patients, 43 (38.1%) had TB on initial sputum screen. 53 (46.9%) had sputum smears negative for TB and 17 (15.0%) were unable to expectorate sputum; of these, 58 (82.9%) agreed to further screening with bronchoscopy. 7 (12.1%) of the BAL specimens had TB on smear, while 14 (24.1%) had TB on culture alone. Cumulatively, 63 (55.8%) patients were diagnosed with TB. 2 (3.5%) patients had Mycobacteria intracellulare and 1 (1.7%) Mycobacterium avium complex. Pneumocystis jirovecii was found in 5 (8.6%), Candida species in 6 (10.3%), Klebsiella in 5 (8.6%) and gram negative enteric bacteria in 2(3.5%). 1 (1.7%) each of Staphylococcus aureus, Streptococcus pneumonia and Proteus mirabilis were cultured. Kaposi’s sarcoma was diagnosed in 3 (5.2%) patients. 1(1.7%) had both TB and PJP. Cause was undetermined in 34 (30.1%).
Conclusion: TB was the major cause of pulmonary disease in this population. Clinical and immunological status did not distinguish the causes of pulmonary disease.
- © 2013 ERS