INFECTION AND MORBIDITY IN PATIENTS WITH TUBERCULOSIS IN NAIROBI, KENYA

Objective: To examine the role of acute infection as a cause of morbidity in patients with tuberculosis. Design: Cross-sectional documentation of predefined acute morbid events. Setting: Infectious Diseases Hospital, Nairobi, Kenya. Patients: Adults (greater-than-or-equal-to 15 years), inpatients and outpatients with a diagnosis of tuberculosis presenting with one or more of a series of clinical features. A new event was defined as one occuring at least 1 week after the initial event. Interventions: Patients' treatment was modified depending on the results of laboratory investigations. Main outcome measures: There were 642 events from 398 patients, 235 HIV-positive patients had 438 events and 163 HIV-negative patients had 204 events (P< 0.0001). Forty-two out of the 235 (18%) HIV-positive patients were bacteraemic compared with nine out of the 163 (6%) HIV-negative patients (P=0.0003). The most common isolates from blood were Salmonella typhimurium and Streptococcus pneumoniae. Results: Faecal specimens were obtained more commonly from HIV-positive patients (P< 0.001), and often contained bacterial pathogens. Conclusions: Many of the causes of morbidity in patients with tuberculosis and HIV are not due to tuberculosis or antituberculous therapy, and will not be identified without microbiological investigation.