Burden of smear negative pulmonary tuberculosis using genexpert and culture methods among human immunodeficiency virus infected patients in tulubolo and St.luke hospital south west shewa, Ethiopia

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Addis Abeba University


Background: Smear negative pulmonary tuberculosis(SNPTB)leads to a serious disease to human immunodeficiency virus infected patients. Therefore knowing the correct diagnostic method improves early detection of the disease.The burden of SNPTB is not known in the study area .Therefore, this study aimed to determine the burden of TB, MDR-TB, in Tulu bolo and St. Luke hospitals,south west shewa Ethiopia. Objective: To determine the burden of SNPTB using genexpert and culture methodsamonghuman immunodeficiency virus infected patients on ART follow up at Tulu bolo Generaland St. Lukas Hospitals in 2012 E.C. Methods: A total of 197informed and consented HIV patients with suspected pulmonary tuberculosis who were presented with pulmonary tuberculosis sign and symptoms of at least 2 weeks or more were screened by FM smear microscopy. All 197 HIV patients’ bothsmear negative and smear positive pooled sputum samples were further tested by gene expert in Tulu bolo general Hospital and St. Luke Hospitals. Simultaneously all smear negative patients and smear positive patients were allowed to give samples which were sent to EPHI for MTB culture (LJ and MGIT), and LPA test.All drug resistant isolates were tested by using Genotype MTBDR plus Ver.2 and first- line MGIT DST.Then the result was collected and data analysis was performed by the use of statistical software epiinfo version 7.2 and SPSS version 23. The study was conducted from December 1, 2019 to February 30, 2020 Results: From the total of 197 enrolled HIV patients, 5/197(2.54%)were smear positive,19/192 (9.9%) were Xpert MTB/ RIF and culture confirmed smear negative PTB patients. The positivity rate among male and female was 10/19 (52.6%) and 9/19(48.4%), respectively. From 19 culture positive isolates, 1 (5.26%) was MDR-TB (resistant to both Rifampicin and Isoniazid); this patient was a female patient under retreatment. Among 19 SNPTB cases14/19(73.68%) patients viral load status were greater than 2001.and about 12/19(63.12%)of 19 SNPTB patients CD4cell result were less than 200 cells per millimetre cube Conclusion: In this study a significant proportion of smear negative pulmonary TB was diagnosed. Further, a smear negative multi drug resistant (MDR) TB was confirmed. Due to thelimitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed, mortality in HIV patients and transmission in the communitycontinues.



ART Patient, Smear negative patient, Detection,Culture,Genexpert, FMmicroscopy, burden