Comeche Belén, Pérez-Butragueño Mario, Górgolas Miguel, Ramos-Rincón José-Manuel
Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, ETH.
Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, ESP.
Cureus. 2023 Feb 27;15(2):e35519. doi: 10.7759/cureus.35519. eCollection 2023 Feb.
Background Ethiopia is one of the countries in the world with the highest rate of tuberculosis (TB). The aim of this study is to describe the characteristics of the patients with TB admitted to a rural hospital in Ethiopia in terms of both diagnosis and clinical management. Methods A retrospective descriptive observational study was conducted. Data were collected from patients older than 13 years who were admitted to the Gambo General Hospital for TB between May 2016 and September 2017. The variables studied were age, sex, symptoms, human immunodeficiency virus (HIV) serology, nutritional status, presence of anemia, chest x-ray or other complementary tests, type of diagnosis (smear microscopy, Xpert MTB-RIF (Cepheid, Sunnyvale, California, USA), or clinical diagnosis), treatment received, outcome, and days of admission. Results One hundred eighty-six patients, aged 13 years and older, were admitted to the TB unit. About 51.6% were female, and the median age was 35 years (interquartile range (IQR) 25-50). Cough was the most frequent symptom on admission (88.7%), and contact with a TB patient was only recognized by 22 patients (11.8%). HIV serology was performed in 148 patients (79.6%); seven were positive (4.7%). About 69.3% met the criteria for malnutrition (body mass index (BMI) <18.5). Most patients, 173 (93%), presented with pulmonary TB and were new cases (94.1%). Patients were diagnosed by clinical parameters in 75% of cases. Smear microscopy was performed in 148 patients, of which 46 (31.1%) were positive, and Xpert MTB-RIF results were only obtained in 16 patients, of which 6 (37.5%) were positive. Chest x-rays were performed in most patients (71%) and were suggestive of TB in 111 (84.1%). The average length of hospital stay was 32 days (confidence interval (CI) 13-50.5). Women tend to be younger than men, have more extrapulmonary TB, and were admitted longer. Nineteen patients died during admission (10.2%). Patients who die were more frequently malnourished (92.9% of those who die were malnourished compared to 67.1% of those who did not die, p = 0.036), tend to be admitted for a shorter time than the survivors and receive more concomitant antibiotic treatment. Conclusions In this rural Ethiopian setting, patients admitted to the hospital for TB are often malnourished (67.1%), the main presentation is pulmonary, mortality is one in 10 admissions and very often receive antibiotics in association with TB treatment (40%).
背景 埃塞俄比亚是世界上结核病发病率最高的国家之一。本研究的目的是从诊断和临床管理方面描述埃塞俄比亚一家乡村医院收治的结核病患者的特征。方法 进行了一项回顾性描述性观察研究。收集了2016年5月至2017年9月期间因结核病入住甘博综合医院的13岁以上患者的数据。研究的变量包括年龄、性别、症状、人类免疫缺陷病毒（HIV）血清学、营养状况、贫血情况、胸部X线或其他辅助检查、诊断类型（涂片显微镜检查、Xpert MTB-RIF（美国加利福尼亚州森尼韦尔市 Cepheid公司产品）或临床诊断）、接受的治疗、结局和住院天数。结果 186名13岁及以上患者入住结核病科。约51.6%为女性，中位年龄为35岁（四分位间距（IQR）25 - 50）。咳嗽是入院时最常见的症状（88.7%），只有22名患者（11.8%）承认与结核病患者有接触。148名患者（79.6%）进行了HIV血清学检测；7名呈阳性（4.7%）。约69.3%符合营养不良标准（体重指数（BMI）<18.5）。大多数患者，173名（93%）表现为肺结核且为新发病例（94.1%）。75%的病例通过临床参数进行诊断。148名患者进行了涂片显微镜检查，其中46名（31.1%）呈阳性，仅16名患者获得了Xpert MTB-RIF检测结果，其中6名（37.5%）呈阳性。大多数患者（71%）进行了胸部X线检查，其中有症状提示结核病的有111名（84.1%）。平均住院时间为32天（置信区间（CI）13 - 50.5）。女性往往比男性年轻，肺外结核更多，住院时间更长。19名患者在住院期间死亡（10.2%）。死亡患者营养不良的情况更常见（死亡患者中有92.9%营养不良，而未死亡患者中为67.1%，p = 0.036），与幸存者相比，住院时间往往更短，且接受更多联合抗生素治疗。结论 在埃塞俄比亚的这个农村地区，因结核病入院的患者往往营养不良（67.1%），主要表现为肺结核，死亡率为十分之一，且在结核病治疗期间经常接受抗生素治疗（40%）。
