Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

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Jill Gersh *
Zachary Feldman
Emily Greenberger
Amit Chandra
Harvey Friedman
Thomas Lere
Ari Ho-Foster
Michelle Haas
(*) Corresponding Author:
Jill Gersh | jgersh@uw.edu

Abstract

Setting: Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP).
Objective: To determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana.
Design: We performed a retrospective study of adults presenting with CAP from April 2010- October 2011 to the Emergency Department (ED); we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. Results: We identified 1,305 individuals presenting with CAP; TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive. The HIV positive rate was 87%.
Conclusion: Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana.


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