The International Journal of Mycobacteriology

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 8  |  Issue : 4  |  Page : 313--319

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


Kenneth Byashalira1, Peter Mbelele3, Hadija Semvua2, Jaffu Chilongola2, Seleman Semvua3, Alphonce Liyoyo5, Blandina Mmbaga2, Sayoki Mfinanga4, Christopher Moore5, Scott Heysell5, Stellah Mpagama1 
1 Kilimanjaro Christian Medical University College; Kibong'oto Infectious Diseases Hospital, Tanzania
2 Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Tanzania
3 Kilimanjaro Christian Medical University College, Tanzania
4 National Institute for Medical Research-Muhimbili Medical Research Centre, Tanzania
5 Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA

Correspondence Address:
Kenneth Byashalira
Kibong'oto Infectious Diseases Hospital, P.O. Box: 12, Siha, Kilimanjaro
Tanzania

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.


How to cite this article:
Byashalira K, Mbelele P, Semvua H, Chilongola J, Semvua S, Liyoyo A, Mmbaga B, Mfinanga S, Moore C, Heysell S, Mpagama S. Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients.Int J Mycobacteriol 2019;8:313-319


How to cite this URL:
Byashalira K, Mbelele P, Semvua H, Chilongola J, Semvua S, Liyoyo A, Mmbaga B, Mfinanga S, Moore C, Heysell S, Mpagama S. Clinical outcomes of new algorithm for diagnosis and treatment of Tuberculosis sepsis in HIV patients. Int J Mycobacteriol [serial online] 2019 [cited 2020 Feb 21 ];8:313-319
Available from: http://www.ijmyco.org/article.asp?issn=2212-5531;year=2019;volume=8;issue=4;spage=313;epage=319;aulast=Byashalira;type=0