Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: clinical, diagnostic and epidemiological characteristics

Scand J Infect Dis. 2002;34(5):331-7. doi: 10.1080/00365540110080025.


In a setting with a high prevalence of HIV we studied (i) the prevalence of pulmonary tuberculosis (PTB) and HIV; (ii) clinical and epidemiological characteristics of PTB; and (iii) the usefulness of standard procedures for diagnosing PTB. Of 509 consecutive outpatients evaluated on clinical suspicion of PTB in Addis Ababa, 33.0% were culture-verified as having PTB. PTB patients, non-TB patients and controls were HIV-1-positive in 57.1%, 38.5% and 8.3% of cases, respectively. Predictors for culture-verified PTB were age < 25 y, male gender and the presence of HIV and fever, whereas profound weight loss indicated HIV infection. Diagnosis of PTB based on clinical symptoms, sputum microscopy for acid-fast bacilli and chest radiography was sensitive (86.7%) but unspecific (64.1%). In HIV-positive patients both sensitivity and specificity were significantly lower (p < 0.05). HIV-related pulmonary infections are often misinterpreted as smear-negative PTB. HIV screening is therefore warranted not only in cases of verified TB but also as part of the diagnostic work-up in patients with respiratory symptoms suggestive of PTB. Also, increased awareness of, and improved diagnostic tools for, HIV-related pulmonary infections other than PTB are required, together with algorithms for patients with suspected PTB.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections* / epidemiology
  • AIDS-Related Opportunistic Infections* / microbiology
  • AIDS-Related Opportunistic Infections* / physiopathology
  • Adolescent
  • Adult
  • Culture Media
  • Ethiopia / epidemiology
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Prevalence
  • Sputum / microbiology
  • Tuberculosis, Pulmonary* / complications
  • Tuberculosis, Pulmonary* / diagnosis
  • Tuberculosis, Pulmonary* / epidemiology
  • Tuberculosis, Pulmonary* / physiopathology


  • Culture Media