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Int J Mycobacteriol. 2019 Oct-Dec;8(4):313-319. doi: 10.4103/ijmy.ijmy_135_19.

Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients.

Author information

1
Kilimanjaro Christian Medical University College; Kibong'oto Infectious Diseases Hospital, Tanzania.
2
Kibong'oto Infectious Diseases Hospital, Tanzania.
3
Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Tanzania.
4
Kilimanjaro Christian Medical University College, Tanzania.
5
National Institute for Medical Research-Muhimbili Medical Research Centre, Tanzania.
6
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.

Abstract

Background:

Despite effort to diagnose tuberculosis (TB) in the Human Immunodeficiency Virus (HIV) infected population, 45% of adults with HIV that had a previously unknown reason for death, demonstrated TB was the cause by autopsy examination. We aimed to assess the clinical outcomes of implementation a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness.

Methods:

This study is a prospective cohort conducted in three-referral hospitals in Kilimanjaro, recruited 97 PLHIV from February through June 2018. Patients provided urine and sputum samples for testing lateral flow - lipoarabinomannan (LF-LAM) and Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays, respectively. Anti-TB was prescribed to patients with positive LF-LAM or Xpert MTB/RIF or received broad-spectrum antibiotics but deteriorated.

Results:

Of 97 patients, 84 (87%) provided urine and sputa, and 13 (13%) provided only urine. The mean age (95% confidence interval) was 40 (38-43) years and 52 (54%) were female. In 84 patients, LF-LAM increased TB detection from 26 (31%) by Xpert MTB/RIF to 41 (55%) by both tests. Of 97 patients, 69 (71%) prescribed anti-TB, 67% (46/69) and 33% (23/69) had definitive and probable TB respectively. Sixteen (16.5%) patients died, of which one died before treatment, 73% (11/15) died within 7 days of admission. The 30-day survival was similar in both treatment groups (log rank = 0.1574). Mortality was significantly higher among hospitalized patients compared to outpatients (P ≤ 0.027).

Conclusion:

Implementation of new algorithm increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay. Survival of PLHIV with confirmed or probable TB was comparable to those of PLHIV that were treated with broad-spectrum antibiotics alone. Further work should focus on the optimal timing and content of the immediate antimicrobial regimen for sepsis among PLHIV in TB-endemic settings.

KEYWORDS:

Lateral flow; PLHIV- danger signs; lipoarabinomannan; tuberculosis

PMID:
31793499
DOI:
10.4103/ijmy.ijmy_135_19
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