Evaluation of the Burden of Unsuspected Pulmonary Tuberculosis and Co-Morbidity with Non-Communicable Diseases in Sputum Producing Adult Inpatients

Matthew Bates,Moses Chilufya,Justin O’Grady,Michael Hoelscher,Judith Mzyece,Lukundo Mukonda,Busiku Cheelo,Nathan Kapata,Maxwell Mumba,Lophina Chilukutu,Mumba Chomba,Alimuddin Zumla,Markus Maeurer,Peter Mwaba,Andrea Rachow,John Tembo,Petra Clowes

doi:10.1371/journal.pone.0040774

Abstract

BackgroundA high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with non-communicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.Methodology/Principal FindingsIn this prospective study, newly admitted adult inpatients able to produce sputum at the University Teaching Hospital, Lusaka, Zambia, were screened for pulmonary TB using fluorescent smear microscopy and automated liquid culture. The burden of pulmonary TB, unsuspected TB, TB co-morbidity with NCDs and CDs was determined. Sputum was analysed from 900 inpatients (70.6% HIV infected) 277 (30.8%) non-TB suspects, 286 (31.8%) TB suspects and 337 (37.4%) were already receiving TB treatment. 202/900 (22.4%) of patients had culture confirmed TB. TB co-morbidity was detected in 20/275 (7.3%) NCD patients, significantly associated with diabetes (P = 0.006, OR 6.571, 95%CI: 1.706–25.3). 27/202 (13.4%) TB cases were unsuspected. There were 18 confirmed cases of MDR-TB, 5 of which were unsuspected.Conclusions/SignificanceA large burden of unsuspected pulmonary TB co-morbidity exists in inpatients with NCDs and other CDs. Pro-active sputum screening of all inpatients in tertiary referral centres in high TB endemic countries is recommended. The scale of the problem of undiagnosed MDR-TB in inpatients requires further study.

Highlights

The WHO estimates that In 2010, there were 1.45 million TBrelated deaths, with the highest burden of tuberculosis (TB) in subSaharan Africa (SSA), where many cases of active TB and drugresistant TB remain undiagnosed [1]
We evaluated the burden of pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre in Zambia
This study found a large burden of pulmonary TB in sputum producing inpatients at a high HIV burden tertiary referral centre in Zambia

Summary

Introduction

The WHO estimates that In 2010, there were 1.45 million TBrelated deaths, with the highest burden of tuberculosis (TB) in subSaharan Africa (SSA), where many cases of active TB and drugresistant TB remain undiagnosed [1] These TB-related deaths often occur at tertiary referral centres, which concentrate a broad range of critically ill patients where the primary admission diagnosis is the focus of medical attention. Tertiary care hospitals like UTH provide an opportunity to study asymptomatic TB, and TB co-morbidity with NCDs and other CDs. We evaluated the burden of pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre in Zambia

Methods and Study

Results

Discussion