Aspects of tuberculosis in Africa. 2. The value of microbiology in the management of tuberculosis in Nairobi, Kenya

Trans R Soc Trop Med Hyg. 1992 Sep-Oct;86(5):470-1. doi: 10.1016/0035-9203(92)90070-s.


A group of African patients with tuberculosis were followed over the first month of treatment to assess the bactericidal response to 2 treatment regimens (streptomycin/thiacetazone/isoniazid and streptomycin/rifampicin/isoniazid/pyrazinamide). Patients also infected with human immunodeficiency virus (HIV) had lower pre-treatment counts of viable Mycobacterium tuberculosis and a greater proportion became culture-negative by 28 d. The response to therapy in HIV positive and HIV negative patients was similar. Because of the combination of these findings and the higher early mortality in patients with HIV, the causes of acute infection in patients with tuberculosis were studied. It was found that HIV positive patients were frequently bacteraemic and that the principal pathogen was Salmonella typhimurium, but recurrent pneumococcal bacteraemia was also seen.

PIP: Two studies of tuberculosis patients in Kenya are summarized in support of management programs that take into account concurrent infections, particularly human immunodeficiency virus (HIV). In the first study, HIV-negative patients had significantly higher (P = 0.019) pretreatment concentrations of Mycobacterium tuberculosis in the sputum. HIV-positive patients had less radiological evidence of disease and fewer cavities in the lungs. Responses to 2 chemotherapeutic regimens, streptomycin/thiacetazone/isoniazid/(STH) vs streptomycin/rifampicin/isoniazid/pyrazinamide (SRHZ), were the same in HIV-positive patients (55% culture-positive after 28 days) while 92% (STH) and 62% (SRHZ) of HIV-negative individuals were culture positive after 28 days. In view of these results, and the high morbidity and mortality of HIV-positive individuals, patients were surveyed in a second study for acute morbid events as defined by clinical signs. Blood and stool specimens were also cultured. Significantly more HIV-positive patients had 2 or more events (P 0.001) and were more likely to be bacteremic (P = 0.0003). The most common isolate was Salmonella typhimurium, but recurrent streptococcus pneumoniae was also seen. Fecal specimens from HIV-positive patients were more likely to be positive for bacterial pathogens (26% vs 7%, P = 0.08).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antitubercular Agents / therapeutic use*
  • Drug Therapy, Combination
  • HIV Infections / complications*
  • HIV Infections / mortality
  • Humans
  • Kenya
  • Mycobacterium tuberculosis / isolation & purification*
  • Tuberculosis / complications
  • Tuberculosis / microbiology*
  • Tuberculosis / mortality


  • Antitubercular Agents