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

• 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
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/429912

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.