Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania

Michael J. Maze Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand;

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Gissela Nyakunga Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;

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Philoteus A. Sakasaka Kilimanjaro Clinical Research Institute, Moshi, Tanzania;

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Kajiru G. Kilonzo Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;

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Elisha Luhwago Mawenzi Regional Referral Hospital, Moshi, Tanzania;

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Manase Chelangwa Ministry of Health and Social Welfare, Dodoma, Tanzania;

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John A. Crump Centre for International Health, University of Otago, Dunedin, New Zealand;

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Riziki M. Kisonga Kibong’oto Infectious Disease Hospital, Kibong’oto, Tanzania;

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Deng B. Madut Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;

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Josephine Rogath Mawenzi Regional Referral Hospital, Moshi, Tanzania;

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Adnan Sadiq Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;

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Rennae Thiessen Radiology Department, Canterbury District Health Board, Christchurch, New Zealand

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Matthew P. Rubach Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;

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ABSTRACT.

Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44–67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.

Author Notes

Address correspondence to Michael J. Maze, Department of Medicine, University of Otago, Christchurch, 2 Riccarton Rd., Christchurch 8011, New Zealand. E-mail: michael.maze@otago.ac.nz

Financial support: This work was supported by the Royal Australasian College of Physicians Foundation Research Establishment Fellowship, a University of Otago Global Health Institute Seed Grant, and a project grant from the W. H. Travis Trust.

Disclosure: The study was performed in accordance with the Declaration of Helsinki and all participants provided informed written consent. The study protocol was approved by the Kilimanjaro Christian Medical University College Research Ethics Committee (reference number 1155), the Tanzania National Institutes for Medical Research National Ethics Coordinating Committee (reference number NIMR/HQ/R.8c/Vol. I/1635), the University of Otago Human Ethics Committee (Health) (reference number H18/123), and the Duke University Institutional Review Board (Pro00103048).

Authors’ addresses: Michael J. Maze, Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand, E-mail: michael.maze@otago.ac.nz. Gissela Nyakunga, Kajiru G. Kilonzo, and Adnan Sadiq, Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mails: gisselanyakunga2021@gmail.com, mtundumliasi@googlemail.com, and adnan.radiologist@gmail.com. Philoteus A. Sakasaka, Kilimanjaro Clinical Research Institute, Moshi, Tanzania, E-mail: psakasaka@yahoo.com. Elisha Luhwago and Josephine Rogath, Mawenzi Regional Referral Hospital, Moshi, Tanzania, E-mails: elichaz90@gmail.com and phinerogath1@gmail.com. Manase Chelangwa, Ministry of Health and Social Welfare, Dodoma, Tanzania, E-mail: gchelangwa@gmail.com. John A. Crump, Centre for International Health, University of Otago, Dunedin, New Zealand, E-mail: john.crump@otago.ac.nz. Riziki M. Kisonga, Kibong’oto Infectious Disease Hospital, Kibong’oto, Tanzania, E-mail: kisongariziki@gmail.com. Deng B. Madut and Matthew P. Rubach, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, E-mails: deng.madut@duke.edu and matthew.rubach@duke.edu. Rennae Thiessen, Radiology Department, Canterbury District Health Board, Christchurch, New Zealand, E-mail: rennae.theissen@cdhb.health.nz.

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