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Background: Disseminated Tuberculosis (TB) has been identified as one of most
common causes of death in adult HIV-infected persons. It has a non-specific clinical
presentation mimicking that of bacterial sepsis requiring a high index of suspicion to
make a diagnosis. The gold standard of diagnosis is blood cultures that have a long
incubation period hence delay in initiation of treatment thus an associated high
mortality rate. The current burden of disseminated TB in adult HIV-infected persons
is not known in Western Kenya. Urinary LAM antigen assay detects the presence of
lipoarabinomannan (LAM), a lipopolysaccharide on the TB cell wall. Its sensitivity
increases with decreasing CD4 counts and in in-patient, PLHIV regardless of their
CD4 counts with a pooled sensitivity of 61% and specificity of 89%.
Broad Objective: To determine the prevalence of disseminated tuberculosis and
describe the clinical characteristics of PLHIV admitted with sepsis at MTRH.
Specific objectives: To determine the prevalence of disseminated tuberculosis in
PLHIV admitted with sepsis at MTRH. To describe the clinical characteristics of
participants with disseminated tuberculosis in PLHIV admitted with sepsis at MTRH.
Methods: A cross sectional study of HIV-infected persons admitted with sepsis
conducted at the MTRH adult medical wards, 300 participants recruited. Interviewer
administered structured questionnaires used to collect data that included
demographics (age and sex); admission vital signs (pulse rate, axillary temperature,
blood pressure, and respiratory rate); HIV associated variables (use of antiretroviral
therapy). Blood samples taken for a full blood count, serum creatinine and urea levels.
A urine sample taken for LAM antigen assay. Data entered into EPIDATA version 13
and analyzed using STATA version 15. Independent variables were summarized
using frequencies (percent), mean (SD) and median (IQR); dependent variables were
analyzed using Student t-test, Chi square and Wilcoxon rank sum test. A significant p
value was less than 0.05.
Results: Two hundred and ninety-eight (298) participants were analyzed; fifty eight
percent (173) were female. Overall mean age was 41.68 (SD 11.72) with no
difference in age between the LAM positive and negative. Prevalence of disseminated
TB 26% (95% CI 21.2-31.4). All participants had anemia with the LAM positive
group having a lower hemoglobin level of 9.71g/dl versus 10.47g/dl in the LAM
negative group (p0.04). One hundred and seventy eight (178) participants had
lymphopenia. Out of the seventy-seven participants with LAM antigen assay positive,
55 had lymphopenia, only two had lymphocytosis and 20 had a normal lymphocyte
count (p 0.04). Out of the seventy-seven participants with LAM antigen assay
positive, fifty-eight were not on HAART with only nineteen being on HAART
(p0.02).Thirty seven percent in the LAM positive group died 10 days from admission
and a further twenty seven percent died within one month (p <0.001).
Conclusion: The prevalence of disseminated TB was 26%. Possible factors
associated with LAM antigen positivity included anemia, lymphopenia and not on
antiretroviral therapy. There was higher mortality seen in the LAM positive group
within 1 month of admission.
Recommendations: LAM antigen assay should be a routine diagnostic test in HIVinfected
persons admitted with sepsis and anti TB medication started promptly due to
the high associated mortality. |
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