The Challenge of Re-Treatment Pulmonary Tuberculosis at two Teaching and Referral Hospitals in Uganda

Background With an annual tuberculosis (TB) incidence of about 350 cases per 100;000 of the population; Uganda is a high burden country. Moreover; it is evident that some TB patients have been treated for a previous episode of the disease. Objective To highlight the burden of re-treatment pulmonary TB and examine patient factors associated with re-treatment among adults at two teaching and referral hospitals; Mbarara and Mulago Methods A descriptive cross sectional study with data collection between September 2004 and March 2005; we calculated the prevalence and used logistic regression to explore factors associated with re-treatment. Results The prevalence of re-treatment pulmo-naryTB at Mbarara based on medical records was 30.0(95CI: 21.2 to 40.0); and 21.3(95CI: 12.9 to 31.8) from exit interviews.The corresponding estimates at Mulago hospital were 12.0(95CI: 6.4 to 20.0) and 43.9(33.0 to 55.3). Compared to the 18-26 year age category; the prevalence odds ratio (POR) for a seven-year increase in age was 1.54 (95CI: 1.04-2.28; p = 0.027); while female patients were 0.39 (95CI: 0.17-0.90; p = 0.025) times less likely to report re-treatment disease than males; in this facility-based study. Conclusions Re-treatment pulmonary TB is frequent at the two teaching and referral hospitals.A contribution to re-treatment prevention should entail more rigorous management of new TB cases; particularly at lower levels of care

Impact of human immunodeficiency virus type-1 infection on the initial bacteriologic and radiographic manifestations of pulmonary tuberculosis in Uganda

Setting : TB Treatment Center; Kampala; Uganda. Objective : To evaluate the impact of Human immunodeficiency virus (HIV) co-infection on the bacteriologic radiographic presentation of pulmonary tuberculosis (TB) in Uganda; a nation with high rates of mycobacterium tuberculosis and HIV infection. Design : To compare baseline characteristics among HIV-infected and non-HIV-infected adults with initial newly-diagonised episodes of culture-confirmed pulmonary tuberculosis screened for participation in a randomised prospective TB treatment trial. Results : Negative and paucibacilliary (very scanty or scanty) sputum acid fast bacilli (AFB) smears were more frequent in HIV-infected patients presenting with pulmonary TB (p

Randomized controlled trial of Mycobacterium vaccae immunotherapy in non-human immunodeficiency virus-infected Ugandan adults with newly diagnosed pulmonary tuberculosis. The Uganda-Case Western Reserve University Research Collaboration

Adjunctive immunotherapy with heat-killed Mycobacterium vaccae was studied in a randomized; placebo-controlled trial of 120 non-human immunodeficiency virus-infected adults with newly diagnosed pulmonary tuberculosis. Patients were randomised to a single dose of M.vaccae or placebo 1 week after beginning chemtherapy and were followed up for 1 year. M.vaccae was safe and well tolerated. the rate of sputum culture conversion after 1 month of tuberculosis treatment was 35in the M.vaccae group and only 14in the placebo group (P=01) but was comparable at 2 months and thereafter. Patients receiving M.vaccae had greater improvement on chest radiography at 6 months (91) vs. 77for placebo recipients; P=04) and 12 months (94vs. 80; P=04) after initiation of tuberculosis treatment. These data provide evidence of an early increase in sputum culture conversion and greater radiographic improvement among patients who received M.vaccae. Further studies are warranted

Radiographic Appearances of Pulmonary Tuberculosis in HIV-1 Seropositive and Seronegative Adult Patients

Objective (of this study is): To describe the radiographic pattern of PTB in HIV-1 seropositive and seronegative patients and to study the relationship between radiographic pattern and degree of immunosuppression based on CD4 counts. Design: Cross-sectional; descriptive study. Setting: TB tratment centre and Department of Radiology; Mulago Referral Hospital and Makerere University Medical Teaching Hospital; Uganda. Subjects: One hundred and fiffty consecutive adult patients; suspected on clinical grounds to have TB. Interventions: Three early morning sputum specicimens and 10 mls of venous blood taken from each qualifying subject. Main outcome measures: Chest x-ray changes and CD4 counts. Results: More than sixty eight per cent of the patients were HIV-1 seropositive. Slightly over seventy two per cent of the seropositives were moderate to severely immunosuppresed; 27.2were mildly immunosuppressed; while 6.4were moderately immunosuppressed. Lung parenchymal opacities were demonstrated in 98.7of all patients. Intrathoracic lymphadenopathy and cavitation were noted in 43.3and 41.3respectively. Fibrosis and pleural effusion were observed in 25.0and 25.3respectively. Miliary disease occurred in 2.0. Seropositives accounted for 81.5and 76.3of patients with lymphadenopathy and pleural effusion; 18.5and 23.7respectively were seronegative. Seronegatives accounted for 64.9and 64.5of those with fibrosis and cavitation respectively; whereas 35.135.5of fibrosis and cavitation respectively were seropostive. Patients who were moderate to severely immunosuppressed accounted for 64.6and 63.2of patients with lymphadenopathy and pleural effusion; 35.4and 36.8respectively had normal immune status or were mildly immunosuppressed.Fibrosis and cavitary disease were more frequent in normal or mildly immunosupressed (78.4and 72.6) than in moderately to severely immunosuppressed patients (21.6and 27.4) (p0.001). Conclusion: HIV-seropositivity with moderate to severe immunosuppression are associated with atypical radiographic appearances in adult post primary PTB

Rifampicin and Thiacetazone Treatment Regimens in HIV Infected Tuberculosis Patients

WHO estimates that more than 5.6 million persons worlswide are dually infected with HIV and M.tuberculosis. HIV confers the greatest known risk for the development of active TB; by reactivating dormant infection; but progressive primary infection. Prior to HIV pandemic; thiatazone was widely used in Tb treatment in developing countries due to its low cost and availability in a combination formulation with isoniazid (INH). In conclusion; the result showed that the rate of adverse drug reactions in the STH arm was more than 12 times higher than in the RHZ arm. Sputum conversion was more rapid in patients treated with RHZ. RHZ is recommended for treatment of tuberculosis in HIV infected persons