Causes of Early Mortality in HIV-Infected TB Suspects in an East African Referral Hospital

Autopsy studies provide the majority of data on the etiology of respiratory infections, a leading cause of death in Africa, particularly among HIV-infected patients. The study authors evaluated pneumonia cases associated with early mortality among hospitalized HIV-infected patients at Mulago Hospital in Kampala.

A prospective cohort study was conducted for HIV-infected patients with at least two weeks of cough admitted to Mulago. Consecutively enrolled patients with negative Ziehl Neelsen sputum smears for acid-fast bacilli underwent bronchoscopy with bronchoalveolar lavage and examination for mycobacteria (smear, solid culture), Pneumocystis jirovecii (Giemsa stain), and fungi (KOH mount, India ink stain, Sabourand culture). Early mortality was defined as death prior to the two-month follow-up visit.

Of the 407 patients enrolled, follow-up data were available for 353 patients (87 percent). Thirty-two percent of patients with follow-up data (112) died within two months. Among patients with early mortality, 66 percent (74) had a confirmed diagnosis of the following: TB (56 percent), cryptococcal pneumonia (1 percent), Pneumocystis pneumonia (3 percent), pulmonary Kaposi sarcoma (4 percent), and pneumonia caused by two or more disease processes (3 percent).

"Mortality in HIV-infected TB suspects is high, with TB associated with the largest proportion of deaths," the authors concluded, noting that "a significant proportion of patients die without a confirmed diagnosis."

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