Prevalence of Disseminated Tuberculosis in HIV-Infected Persons Admitted with Sepsis at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Disseminated Tuberculosis (TB) is associated with high morbidity and mortality in HIV-infected persons. The clinical presentation mimics that of sepsis hence requires a high index of suspicion to make a diagnosis. Gold standard of diagnosis is blood cultures that have a long incubation period thus delay in initiation of treatment. Current burden of disseminated TB in adult HIV-infected persons is not known in Western Kenya. Objectives: To determine the prevalence of disseminated TB and the clinical characteristics of HIV-infected persons with disseminated TB. Methods: A cross sectional study carried out at the Moi Teaching and Referral Hospital (MTRH) medical wards. Within 24 hours of admission the interviewer administered the questionnaire, and blood and urine samples were collected. Independent variables were summarized using frequencies (%), mean (SD) and median (IQR); dependent variables were analyzed using Student t-test, Chi square and Wilcoxon rank sum test. A p ≤ 0.05 was considered significant. Results: From April to September 2017, 298 participants were recruited; 58% (173) were female, mean age was 41.68 (SD 11.72). The prevalence of disseminated TB was 26% (95% CI 21.2-31.4). The LAM positive group had a lower hemoglobin level of 9.71g/dl versus 10.47g/dl in the LAM negative group (p0.04). Sixty percent (178) of the participants had lymphopenia with 31% of them having LAM antigen positive versus 69% having LAM antigen negative (p 0.04). One hundred and ninety-three participants (193) were not on antiretroviral therapy with 30% of them having LAM antigen positive versus 70% of them having LAM antigen negative (p 0.02). Conclusion: The prevalence of disseminated TB in this setting was 26%. Possible factors associated with LAM antigen positivity included anemia, lymphopenia and not on antiretroviral therapy. Recommendations: LAM antigen assay should be a routine diagnostic test in HIV-infected persons admitted with sepsis