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


Submitted: 18 October 2017
Accepted: 19 January 2018
Published: 21 May 2018
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Authors

  • Jill K. Gersh Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
  • Zachary Feldman Department of Economics, University of Colorado, Boulder, CO; Albers School of Business and Economics, Seattle University, Seattle, WA, United States.
  • Emily Greenberger Botswana UPenn Partnership, Gaborone, Botswana; Division of Infectious Disease, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
  • Amit Chandra Princess Marina Hospital and Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, Botswana.
  • Harvey M. Friedman University of Pennsylvania, Medicine/Infectious Botswana UPenn Partnership, Gaborone, Botswana; Division of Infectious Disease, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PADisease, USA; Botswana UPenn Partnership, Botswana.
  • Thomas Lere Botswana National Tuberculosis Programme, Botswana.
  • Ari Ho-Foster Botswana UPenn Partnership, Gaborone, Botswana; Division of Infectious Disease, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
  • Michelle Haas Botswana UPenn Partnership, Gaborone, Botswana; Division of Infectious Disease, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Denver Metro Tuberculosis Program, Denver Public Health, Denver, CO, United States.

Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. 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. We identified 1305 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 and 87% were identified as being HIV-positive. 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.


Supporting Agencies

Princess Marina Hospital, Gaborone, Botswana, Botswana-UPenn Partnership, University of Pennsylvania

Gersh, J. K., Feldman, Z., Greenberger, E., Chandra, A., Friedman, H. M., Lere, T., Ho-Foster, A., & Haas, M. (2018). Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana. Journal of Public Health in Africa, 9(1). https://doi.org/10.4081/jphia.2018.803

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