TB presenting as community-acquired pneumonia in a setting of high TB incidence and high HIV prevalence

Abstract

Setting: Sub-Saharan Africa has the highest prevalence of human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS) and a high incidence of tuberculosis (TB).

Objectives: To determine the aetiology of and mortality due to community-acquired pneumonia (CAP) in HIV and non-HIV-infected adults.

Methods: Consecutive patients with CAP admitted to a teaching hospital in KwaZulu-Natal over a 17-month period were studied prospectively. Systematic investigation of samples of sputum and blood cultures was performed. A subset of patients had urine antigen tests and serum serology.

Results: A total of 430 patients with a mean age of 33 years (range 18-82) were enrolled. Of the 382 patients tested, 311 (81.4%) were HIV-infected. Pathogens were isolated in 222 patients (52%). The most common organisms were Mycobacterium tuberculosis (39.6%) and Streptococcus pneumoniae (34.5%). M. tuberculosis was the most common agent in both HIV and non-HIV-infected subjects (40% and 35%, respectively). In-hospital mortality was 17% overall, 15.9% in the HIV-infected, 25% in the non-HIV-infected and 38% in patients with polymicrobial infections.

Conclusions: M. tuberculosis was the leading cause of CAP and reflects the worsening TB epidemic in the region. Aggressive intervention is required to address both the HIV and TB epidemics in sub-Saharan Africa.