Objective: To examine the role of acute infection as a cause of morbid
ity in patients with tuberculosis. Design: Cross-sectional documentati
on of predefined acute morbid events. Setting: Infectious Diseases Hos
pital, Nairobi, Kenya. Patients: Adults (greater-than-or-equal-to 15 y
ears), inpatients and outpatients with a diagnosis of tuberculosis pre
senting with one or more of a series of clinical features. A new event
was defined as one occuring at least 1 week after the initial event.
Interventions: Patients' treatment was modified depending on the resul
ts of laboratory investigations. Main outcome measures: There were 642
events from 398 patients, 235 HIV-positive patients had 438 events an
d 163 HIV-negative patients had 204 events (P< 0.0001). Forty-two out
of the 235 (18%) HIV-positive patients were bacteraemic compared with
nine out of the 163 (6%) HIV-negative patients (P=0.0003). The most co
mmon isolates from blood were Salmonella typhimurium and Streptococcus
pneumoniae. Results: Faecal specimens were obtained more commonly fro
m HIV-positive patients (P< 0.001), and often contained bacterial path
ogens. Conclusions: Many of the causes of morbidity in patients with t
uberculosis and HIV are not due to tuberculosis or antituberculous the
rapy, and will not be identified without microbiological investigation
.