Okwera Alphonse, Bwanga Freddie, Najjingo Irene, Mulumba Yusuf, Mafigiri David K, Whalen Christopher C, Joloba Moses L
Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
PLoS One. 2013 Dec 3;8(12):e82257. doi: 10.1371/journal.pone.0082257. eCollection 2013.
Previously treated TB patients with pulmonary symptoms are often considered recurrent TB suspects in the resource-limited settings, where investigations are limited to microscopy and chest x-ray. Category II anti-TB drugs may be inappropriate and may expose patients to pill burden, drug toxicities and drug-drug interactions.
To determine the causes of pulmonary symptoms in HIV-infected smear negative recurrent pulmonary tuberculosis suspects at Mulago Hospital, Kampala.
Between March 2008 and December 2011, induced sputum samples of 178 consented HIV-infected smear negative recurrent TB suspects in Kampala were subjected to MGIT and LJ cultures for mycobacteria at TB Reference Laboratory, Kampala. Processed sputum samples were also tested by PCR to detect 18S rRNA gene of P.jirovecii and cultured for other bacteria.
Bacteria, M. tuberculosis and Pneumocystis jirovecii were detected in 27%, 18% and 6.7% of patients respectively and 53.4% of the specimens had no microorganisms. S. pneumoniae, M. catarrhalis and H. influenzae were 100% susceptible to chloramphenicol and erythromycin but co-trimoxazole resistant.
At least 81.5% of participants had no microbiologically-confirmed TB. However our findings call for thorough investigation of HIV-infected smear negative recurrent TB suspects to guide cost effective treatment.
在资源有限的环境中，既往接受过治疗且有肺部症状的结核病患者常被视为复发性结核病疑似病例，那里的检查仅限于显微镜检查和胸部X光检查。二类抗结核药物可能并不合适，且可能使患者承受药物负担、药物毒性及药物相互作用。
确定坎帕拉穆拉戈医院感染艾滋病毒、涂片阴性的复发性肺结核疑似病例出现肺部症状的原因。
2008年3月至2011年12月期间，坎帕拉178名同意参与的感染艾滋病毒、涂片阴性的复发性结核病疑似病例的诱导痰标本，在坎帕拉结核病参考实验室接受分枝杆菌的MGIT和LJ培养。处理后的痰标本也通过PCR检测耶氏肺孢子菌的18S rRNA基因，并培养其他细菌。
分别在27%、18%和6.7%的患者中检测到细菌、结核分枝杆菌和耶氏肺孢子菌，53.4%的标本未检测到微生物。肺炎链球菌、卡他莫拉菌和流感嗜血杆菌对氯霉素和红霉素100%敏感，但对复方新诺明耐药。
至少81.5%的参与者没有微生物学确诊的结核病。然而，我们的研究结果呼吁对感染艾滋病毒、涂片阴性的复发性结核病疑似病例进行彻底调查，以指导具有成本效益的治疗。
