THE BACTERIOLOGY OF PULMONARY TUBERCULOSIS IN A POPULATION WITH HIGH HUMAN-IMMUNODEFICIENCY-VIRUS SEROPREVALENCE

SETTING: A public sector urban university hospital in Soweto, South Af rica. OBJECTIVE: TO describe the utility of sputum smear microscopy an d the prevalence of Mycobacterium tuberculosis resistance to antituber culosis drugs according to human immunodeficiency virus (HIV) serostat us in adults. DESIGN: A retrospective descriptive study of consecutive cases using a record review. RESULTS: We studied 412 adults with cult ure-proven pulmonary tuberculosis, of whom 185 (44.9%) were HIV-seropo sitive and had a significantly lower sputum smear positivity than HIV seronegatives (68% versus 79%, P < 0.05). Smear positivity was signifi cantly higher in HIV-infected patients with CD4 counts less than or eq ual to 50/mm(3) compared to those with CD4 counts of 201-300/mm(3) (P < 0.05). In patients with and those without a history of previous trea tment for tuberculosis, resistance to one or more antituberculosis dru gs was found in 32.2% and 13.6% of cases, respectively, while resistan ce to both isoniazid and rifampicin (multidrug-resistant tuberculosis [MDR]) was found in 15.3% and 4.5% of patients, respectively. There wa s no significant difference in resistance between HIV-positive and ser onegative patients. CONCLUSION: A strong tuberculosis control programm e and good surveillance will be required to prevent the further spread of MDR tuberculosis. Surveys such as these are useful for monitoring control programmes.