HIV and tuberculosis in a rural hospital in Kenya.

OBJECTIVE: To document the incidence and prevalence of HIV infection and TB in patients attending a rural Kenyan hospital. DESIGN: A retrospective analysis of newly diagnosed HIV and TB-infected patients, HIV and TB-related admissions, and results of blood donor screening for HIV from 1993 to 1997. SETTING: PCEA Chogoria Hospital, Eastern Province, Kenya. SUBJECTS: Patients diagnosed with HIV infection and/or TB; all blood donors. INTERVENTION: Diagnosis of pulmonary TB by Ziehl-Neelsen staining of sputum smears; diagnosis of smear negative and extrapulmonary TB based on consistent clinical and radiological features; HIV-1 and HIV-2 testing of patients clinically suspected to be infected and all blood donors. MAIN OUTCOME MEASURES: Patients diagnosed with HIV and/or TB from 1993 to 1997; the number of HIV and TB related admissions and the associated mortality rates. RESULTS: A rising incidence of newly diagnosed HIV patients is documented, and an increasing number of TB patients are co-infected with HIV. The number of HIV inpatient episodes is increasing, against a background of falling inpatient and outpatient episodes. HIV seroprevalence among blood donors is stable at 3-4%. The proportion of TB patients suffering from extrapulmonary TB is increasing (p=0.011), probably as a result of the increase in HIV. CONCLUSION: The HIV epidemic is having an increasing impact on rural Kenyans' health, although background seroprevalence rates are apparently stable. TB patients co-infected with HIV are placing a growing burden on health care resources. All health care facilities face a challenge as to how best to use limited resources to combat both these deadly diseases.

Non-tuberculous mycobacteria in cystic fibrosis.

BACKGROUND: The clinical significance of the presence of non-tuberculous mycobacteria in the sputum of patients with cystic fibrosis is unclear. A retrospective case-control study was performed to assess possible risk factors for non-tuberculous mycobacteria and its impact on clinical status in patients with cystic fibrosis. METHODS: The records of all patients attending the Leeds cystic fibrosis clinics who were positive for non-tuberculous mycobacteria were examined. Each case was matched with two controls for sex, age, and respiratory function at the time of the first non-tuberculous mycobacteria isolate. Details of respiratory function, nutritional status, antibiotic and corticosteroid therapy, Shwachman-Kulczycki (S-K) score, Northern chest radiographic score, and the frequency of isolation of other bacteria and fungi were collected from two years before to two years after the first non-tuberculous mycobacteria isolate. The patients' genotype and the presence of diabetes mellitus were also recorded. RESULTS: Non-tuberculous mycobacteria were isolated from 14 patients out of a cystic fibrosis population of 372 (prevalence = 3.8%). No significant effect of non-tuberculous mycobacteria was seen on respiratory function, nutritional status, or S-K score. There was a significant association with the number of intravenous antibiotic courses received before the first isolate with cases receiving, on average, twice as many courses as controls (cases 6.64, controls 2.86, 95% CI for difference 1.7 to 5.9). No significant difference was seen between cases and controls for Northern scores, previous steroid therapy, or the incidence of diabetes mellitus. CONCLUSIONS: Non-tuberculous mycobacteria infection in patients with cystic fibrosis is uncommon and its clinical impact appears to be minimal over a two year period. Frequent intravenous antibiotic usage is a possible risk factor for colonisation with non-tuberculous mycobacteria.