Munyati Shungu S, Dhoba Temba, Makanza Evelyn D, Mungofa Stanley, Wellington Maureen, Mutsvangwa Junior, Gwanzura Lovemore, Hakim James, Nyakabau Morgan, Mason Peter R, Robertson Valerie, Rusakaniko Simba, Butterworth Anthony E, Corbett Elizabeth L
National Institute of Health Research, Harare, Zimbabwe.
Clin Infect Dis. 2005 Jun 15;40(12):1818-27. doi: 10.1086/429912. Epub 2005 May 12.
Cough lasting for > or = 3 weeks (i.e., chronic cough) indicates that a patient has suspected tuberculosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficiency virus (HIV) infection.
A total of 544 adults with chronic cough were recruited systematically from 2 primary health care clinics, and they were evaluated using preset first- and second-line investigations and diagnostic case definitions.
The overall prevalence of HIV infection among the study cohort was 83%. TB was the most common diagnosis, with 207 HIV-positive patients (46%) and 27 HIV-negative patients (30%) having confirmed or probable TB. Of these, 145 HIV-positive patients with TB (70%) and 20 HIV-negative patients with TB (74%) had smear-positive cases of TB. Only 17 HIV-positive and 2 HIV-negative patients had smear-negative but culture-positive cases of TB. Lower respiratory tract infections (n = 178; HIV prevalence, 79%) and pneumonia (n = 87; HIV prevalence, 89%) were the next most common diagnoses. Asthma (n = 26; HIV prevalence, 46%), posttuberculous disease and other fibrotic lung disease (n = 34; HIV prevalence, 88%), and cardiac disease (n = 15; HIV prevalence, 93%) were more common than were Pneumocystis jiroveci pneumonia and cryptococcosis (n = 8 and n = 5, respectively; HIV prevalence, 100%), and we found no cases of nocardiosis or histoplasmosis.
TB was diagnosed for 43% of patients who presented with chronic cough to primary health care clinics in Harare, with 71% having smear-positive disease. The findings of TB culture added relatively little to the findings of fluorescent microscopy of concentrated sputum specimens. The prevalence of HIV infection was high across a range of diagnoses, suggesting that an HIV test should be recommended in the initial investigation of chronic cough.
咳嗽持续≥3周（即慢性咳嗽）提示患者疑似患有结核病（TB）。在初级卫生保健层面，在人类免疫缺陷病毒（HIV）感染率较高的环境中，此前尚未对导致慢性咳嗽的疾病谱进行过调查。
从2家初级卫生保健诊所系统招募了544例患有慢性咳嗽的成年人，并使用预设的一线和二线检查及诊断病例定义对他们进行评估。
研究队列中HIV感染的总体患病率为83%。结核病是最常见的诊断，207例HIV阳性患者（46%）和27例HIV阴性患者（30%）确诊或疑似患有结核病。其中，145例HIV阳性结核病患者（70%）和20例HIV阴性结核病患者（74%）痰涂片阳性。只有17例HIV阳性和2例HIV阴性患者痰涂片阴性但培养阳性。下呼吸道感染（n = 178；HIV患病率79%）和肺炎（n = 87；HIV患病率89%）是其次最常见的诊断。哮喘（n = 26；HIV患病率46%）、结核后疾病和其他纤维化肺病（n = 34；HIV患病率88%）以及心脏病（n = 15；HIV患病率93%）比耶氏肺孢子菌肺炎和隐球菌病更常见（分别为n = 8和n = 5；HIV患病率100%），且未发现诺卡菌病或组织胞浆菌病病例。
在哈拉雷的初级卫生保健诊所，43%表现为慢性咳嗽的患者被诊断为结核病，其中71%痰涂片阳性。结核培养结果对浓缩痰标本荧光显微镜检查结果的补充相对较少。在一系列诊断中HIV感染患病率都很高，这表明在慢性咳嗽的初始调查中应建议进行HIV检测。
