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Tuberculosis in HIV-infected South African children with complicated severe acute malnutrition.

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Adler, Hugh ORCID: https://orcid.org/0000-0003-4437-2298, Archary, M, Mahabeer, P, LaRussa, P and Bobat, R A (2017) 'Tuberculosis in HIV-infected South African children with complicated severe acute malnutrition.'. International Journal of Tuberculosis and Lung Disease, Vol 21, Issue 4, pp. 438-445.

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Abstract

Academic tertiary referral hospital in Durban, South Africa. To describe the incidence and diagnostic challenges of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children with severe acute malnutrition (SAM). Post-hoc analysis of a randomised controlled trial that enrolled antiretroviral therapy naïve, HIV-infected children with SAM. Trial records and hospital laboratory results were explored for clinical diagnoses and bacteriologically confirmed cases of TB. Negative binomial regression was used to explore associations with confirmed cases of TB, excluding cases where the clinical diagnosis was not supported by microbiological confirmation. Of 82 children enrolled in the study, 21 (25.6%) were diagnosed with TB, with bacteriological confirmation in 8 cases. Sputum sampling (as opposed to gastric washings) was associated with an increased risk of subsequent diagnosis of TB (adjusted relative risk [aRR] 1.134, 95%CI 1.02-1.26). Culture-proven bacterial infection during admission was associated with a reduced risk of TB (aRR 0.856, 95%CI 0.748-0.979), which may reflect false-negative microbiological tests secondary to empiric broad-spectrum antibiotics. TB is common in HIV-infected children with SAM. While microbiological confirmation of the diagnosis is feasible, empiric treatment remains common, possibly influenced by suboptimal testing and false-negative TB diagnostics. Rigorous microbiological TB investigation should be integrated into the programmatic management of HIV and SAM.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Nutrition Disorders > WD 100 General works
WD Disorders of Systemic, Metabolic or Environmental Origin, etc > Nutrition Disorders > WD 105 Deficiency diseases
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WS Pediatrics > WS 100 General works
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 115 Nutritional requirements. Nutrition disorders
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.16.0753
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 24 Apr 2017 15:53
Last Modified: 12 Jul 2018 15:27
URI: http://archive.lstmed.ac.uk/id/eprint/6951

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