Clinical Predictors and Accuracy of Empiric Tuberculosis Treatment among Sputum Smear-Negative HIV-Infected Adult TB Suspects in Uganda

Lydia Nakiyingi, John Mark Bwanika, Bruce Kirenga, Damalie Nakanjako, Catherine Katabira, Gloria Lubega, Joseph Sempa, Barnabas Nyesiga, Heidi Albert, Yukari C Manabe

Research output: Contribution to journalArticle

Abstract

Introduction:The existing diagnostic algorithms for sputum smear-negative tuberculosis (TB) are complicated, time-consuming, and often difficult to implement. The decision to initiate TB treatment in resource-limited countries is often largely based on clinical predictors. We sought to determine the clinical predictors and accuracy of empiric TB treatment initiation in HIV-infected sputum smear-negative TB suspects using sputum culture as a reference standard.Setting:Out-patient HIV-TB integrated urban clinic in Kampala, Uganda.Methods:HIV-infected TB suspects were screened using sputum smear microscopy, and mycobacterial sputum liquid and solid cultures were performed. Smear results were made available to the clinician who made a clinical decision on empiric TB treatment initiation for sputum smear-negative patients. Clinic records were reviewed for patients whose sputum smears were negative to collect data on socio-demographics, TB symptomatology, chest X-ray findings, CD4 cell counts and TB treatment initiation.Results:Of 253 smear-negative TB suspects, 56% (142/253) were females, median age 38 IQR (31-44) years, with a median CD4 cell count of 291 IQR (150-482) cells/mm3. Of the 85 (33.6%) smear-negative patients empirically initiated on TB treatment, 35.3% (n = 30) were sputum culture positive compared to only 18 (10.7%) of the 168 untreated patients (p

Original languageEnglish (US)
Article numbere74023
JournalPLoS One
Volume8
Issue number9
DOIs
StatePublished - Sep 6 2013

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Uganda
Sputum
tuberculosis
Microscopic examination
Tuberculosis
HIV
X rays
Liquids
Therapeutics
CD4 Lymphocyte Count
reference standards
chest
cells
Microscopy
microscopy
X-radiation
Outpatients
Thorax
demographic statistics
X-Rays

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Clinical Predictors and Accuracy of Empiric Tuberculosis Treatment among Sputum Smear-Negative HIV-Infected Adult TB Suspects in Uganda. / Nakiyingi, Lydia; Bwanika, John Mark; Kirenga, Bruce; Nakanjako, Damalie; Katabira, Catherine; Lubega, Gloria; Sempa, Joseph; Nyesiga, Barnabas; Albert, Heidi; Manabe, Yukari C.

In: PLoS One, Vol. 8, No. 9, e74023, 06.09.2013.

Research output: Contribution to journalArticle

Nakiyingi, L, Bwanika, JM, Kirenga, B, Nakanjako, D, Katabira, C, Lubega, G, Sempa, J, Nyesiga, B, Albert, H & Manabe, YC 2013, 'Clinical Predictors and Accuracy of Empiric Tuberculosis Treatment among Sputum Smear-Negative HIV-Infected Adult TB Suspects in Uganda', PLoS One, vol. 8, no. 9, e74023. https://doi.org/10.1371/journal.pone.0074023
Nakiyingi, Lydia ; Bwanika, John Mark ; Kirenga, Bruce ; Nakanjako, Damalie ; Katabira, Catherine ; Lubega, Gloria ; Sempa, Joseph ; Nyesiga, Barnabas ; Albert, Heidi ; Manabe, Yukari C. / Clinical Predictors and Accuracy of Empiric Tuberculosis Treatment among Sputum Smear-Negative HIV-Infected Adult TB Suspects in Uganda. In: PLoS One. 2013 ; Vol. 8, No. 9.
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