Chronic Cough in Primary Health Care Attendees, Harare, Zimbabwe: Diagnosis and Impact of HIV Infection

Background. Cough lasting for ⩾3 weeks (i.e., chronic cough) indicates that a patient has suspected tuberculosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficienc...

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Published in:	Clinical infectious diseases Vol. 40; no. 12; pp. 1818 - 1827
Main Authors:	Munyati, Shungu S., Dhoba, Temba, Makanza, Evelyn D., Mungofa, Stanley, Wellington, Maureen, Mutsvangwa, Junior, Gwanzura, Lovemore, Hakim, James, Nyakabau, Morgan, Mason, Peter R., Robertson, Valerie, Rusakaniko, Simba, Butterworth, Anthony E., Corbett, Elizabeth L.
Format:	Journal Article
Language:	English
Published:	Chicago, IL The University of Chicago Press 15-06-2005 University of Chicago Press Oxford University Press
Subjects:	Adolescent Adult AIDS Bacterial diseases Biological and medical sciences Chronic Disease Cohort Studies Cough Cough - diagnosis Female HIV HIV infections HIV Infections - complications HIV Infections - diagnosis HIV Infections - epidemiology HIV/AIDS Human bacterial diseases Human immunodeficiency virus Human viral diseases Humans Infectious diseases Lung diseases Male Medical diagnosis Medical sciences Microscopy Pneumocystis Pneumology Primary care Primary Health Care Prospective Studies Pulmonary tuberculosis Radiology Respiratory system : syndromes and miscellaneous diseases Sputum Tuberculosis Tuberculosis and atypical mycobacterial infections Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - epidemiology Tuberculosis, Pulmonary - etiology Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Zimbabwe - epidemiology Zimbabwe Africa Harare Zimbabwe Histoplasmosis Pneumonia Mycosis Primary health care Cardiovascular disease Mycobacterial infection Fungi Nocardiosis Heart disease Bronchus disease Obstructive pulmonary disease Fungi Imperfecti Diagnosis Thallophyta Immunopathology Lung disease Respiratory disease Chronic disease Actinomycosis Cryptococcosis Retroviridae AIDS Immune deficiency Lentivirus Cough Asthma Infection Virus Chronic Tuberculosis Viral disease Bacteriosis Pneumocystis Human immunodeficiency virus Pneumopathy
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Summary:	Background. Cough lasting for ⩾3 weeks (i.e., chronic cough) indicates that a patient has suspected tuberculosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficiency virus (HIV) infection. Methods. A total of 544 adults with chronic cough were recruited systematically from 2 primary health care clinics, and they were evaluated using preset first- and second-line investigations and diagnostic case definitions. Results. The overall prevalence of HIV infection among the study cohort was 83%. TB was the most common diagnosis, with 207 HIV-positive patients (46%) and 27 HIV-negative patients (30%) having confirmed or probable TB. Of these, 145 HIV-positive patients with TB (70%) and 20 HIV-negative patients with TB (74%) had smear-positive cases of TB. Only 17 HIV-positive and 2 HIV-negative patients had smear-negative but culture-positive cases of TB. Lower respiratory tract infections (n = 178; HIV prevalence, 79%) and pneumonia (n = 87; HIV prevalence, 89%) were the next most common diagnoses. Asthma (n = 26; HIV prevalence, 46%), posttuberculous disease and other fibrotic lung disease (n = 34; HIV prevalence, 88%), and cardiac disease (n = 15; HIV prevalence, 93%) were more common than werePneumocystis jiroveci pneumonia and cryptococcosis (n = 8 andn = 5, respectively; HIV prevalence, 100%), and we found no cases of nocardiosis or histoplasmosis. Conclusions. TB was diagnosed for 43% of patients who presented with chronic cough to primary health care clinics in Harare, with 71% having smear-positive disease. The findings of TB culture added relatively little to the findings of fluorescent microscopy of concentrated sputum specimens. The prevalence of HIV infection was high across a range of diagnoses, suggesting that an HIV test should be recommended in the initial investigation of chronic cough.
Bibliography:	Formerly Blair Research Institute. ark:/67375/HXZ-CW5WCHG4-T istex:E7FE0770CD612A0D8C4C06D76EA1091640E0E4CC ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	1058-4838 1537-6591
DOI:	10.1086/429912