'Smear-negative' pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence

Int J Tuberc Lung Dis. 2001 Sep;5(9):847-54.


Setting: Lilongwe Central Hospital, Malawi.

Objectives: To investigate 1) treatment outcome of a cohort of smear-negative pulmonary TB (snPTB) patients in an area of high human immunodeficiency virus (HIV) seroprevalence, and 2) whether poor treatment outcomes are due to non-TB patients being mistakenly treated for TB due to lack of diagnostic facilities.

Design: Patients about to be registered for snPTB treatment by the National TB Programme underwent further assessment including TB culture, bronchoscopy and bronchoalveolar lavage. All patients were followed up for 8 months. Standard TB control treatment outcomes were recorded.

Results: Of 352 snPTB patients assessed, 137 patients had bacteriologically confirmed TB, 136 had possible TB, and 79 had other non-TB diagnoses. The HIV seroprevalence rate was 89%. Outcomes were known for 325 (92%) patients: 129 (40%) died within 8 months. Death rates on TB treatment were 31% for bacteriologically confirmed TB patients and 35% for patients with possible TB but no bacteriological diagnosis. The death rate among patients with non-TB diagnoses was 53%. HIV infection significantly increased the risk of death (OR 3.9; P = 0.01).

Conclusion: SnPTB is strongly associated with HIV infection in Malawi, where patients treated for snPTB have a poor prognosis. The high mortality is not fully explained by non-TB patients being mistakenly treated for TB.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use*
  • Bronchoscopy
  • Cause of Death
  • Cohort Studies
  • Directly Observed Therapy*
  • False Positive Reactions
  • Female
  • HIV Seroprevalence*
  • Humans
  • Malawi
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification
  • Odds Ratio
  • Prognosis
  • Sputum / microbiology
  • Treatment Outcome
  • Tuberculosis, Pulmonary / diagnosis*
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / mortality


  • Antitubercular Agents