Tuberculosis rural Uganda

Uganda is among the 22 countries concentrating 80 % of the tuberculosis (TB) burden in the world.1 since 1995 the case notification rate has been increasing yearly by 10 %. Thirty-seven thousand new cases (all TB forms) were diagnosed in 2001 (132 per 100 000 inhabitants). It has been estimated though that the number of new patients detected with a positive smear for acid-fast bacilli (AFB) represents just over half of the existing cases. These numbers may be even higher: a household survey in the capital Kampala showed an unexpected high rate of TB; more than half of the cases found had not been detected before the survey.

A total of 680 patients were registered and evaluated. There were 364 males (54 %). The median age for males was 35 years (range: 1–75) and for females 29 years (range: 4–75). Two hundred and ninety-seven patients (44 %) lived in Mayuge District, 279 (41 %) were from bordering districts and 104 (15 %) from other districts. The BMI could be calculated on admission in 576 patients (297 males and 246 females); 169 males (57 %) and 144 females (59 %) had a moderate or severe degree of malnutrition. Patients’ categories and clinical forms are shown in the Table. The anatomical sites of EPTB were: pleura: 53; lymph nodes: 29; larynx: 19; pericardium: 15; bone: seven; meninges: four; abdomen: two; psoas, kidneys, breast, endometrium, and preauricular and lumbar abscess: one each (several patients had more than one site involved). Forty-six (33 %) patients with EPTB had a biopsy compatible with TB or a positive AFB smear (among those also having PTB). Among patients with PTB who had a radiograph 113 (32 %) had cavitary lesions; 15 patients presented with a pneumothorax.

During the study period, testing for the human immunodeficiency virus (HIV) infection was not available at SFH. Among the 102 patients who had been tested in

another facility, 68 patients (68 %) were infected. The rate of infection was not significantly different between sexes: 29 males (60 %) and 15 females (72 %) (p> 0.05). Among those not tested, clinical findings (oral thrush, herpes zoster, Kaposi’s sarcoma, cryptococcal meningitis, prolonged diarrhoea, and acute respiratory distress responding to Pneumocystis pneumonia treatment) suggested HIV infection in an additional 45 patients (8 %).

Drug susceptibility testing (DST) was not performed in our laboratory but resistance to anti-TB drugs was demonstrated in 17 patients at the National Reference Laboratory: to E in three patients; to E and S, to H and E, and to H and S in one patient each; to H, E and S in two patients; nine patients harboured bacilli resistant to H, R, E and S. As second-line anti-TB medications were not available this last group of patients was advised not to return for treatment.