Date Published: April 23, 2012
Publisher: BioMed Central
Author(s): Emmanuel Luyirika, Henry Nsobya, Richard Batamwita, Pheona Busingye, William Musoke, Lillian Nabiddo, Yvonne Karamagi, Barbara Mukasa.
This case report describes an HIV-positive patient with recurrent tuberculosis in Uganda. After several failed courses of treatment, the patient was diagnosed with multi-drug resistant tuberculosis (MDR-TB). As adequate in-patient facilities were unavailable, we advised the patient to remain at home, and he received treatment at home via his family and a community nurse. The patient had a successful clearance of tuberculosis. This strategy of home-based care represents an important opportunity for treatment of patients in East Africa, where human resource constraints and inadequate hospital facilities exist for complex patients at high risk of infection to others.
Successful treatment of multi-drug resistant tuberculosis (MDR-TB) in HIV-positive patients is a challenge in resource-limited settings. In Uganda, the exact magnitude of MDR-TB is not known, though a national drug resistance survey is ongoing. To date, there has not been any reported successful treatment of MDR-TB using the home-based approach in East Africa. However, a recent study conducted in South Africa found that a similar approach has been effective . In a first attempt, Mildmay Uganda has successfully treated a patient with MDR-TB using a home-based approach.
A 42-year old HIV-positive male, in a discordant relationship, presented to the Mildmay Uganda clinic with a long-standing cough, chest and abdominal pain, night sweats, and impairment of short-term memory. The patient had two previous episodes of pulmonary tuberculosis (TB), and on both occasions, this condition was managed in hospital, and he completed treatment in accordance with the Uganda Ministry of Health TB program standard regimes (2RHZE/6EH and 2RHZES/1RHZE/5RHE) . On examination in March 2007, the patient had consolidation of the upper lobe of the left lung. Investigations showed the sputum ZN smear positive for AFBs (3+). A diagnosis of TB was made, and the patient started TB treatment (2RHEZS/1REHZ/5REH), as per standard guidelines . A sputum sample was sent to the Ugandan National TB laboratory for mycobacterium culture; results indicated innumerable mycobacterium colonies, but unfortunately the laboratory could not perform drug sensitivity tests at that time. Follow-up ZN sputum smears performed 3 months after the patient started treatment were still positive for AFBs.
This case report from Mildmay Uganda demonstrates successful treatment of MDR-TB using a home-based approach in Uganda. To our knowledge, this is the first reported home-based care of MDR-TB from East Africa. In many settings in Sub-Saharan Africa, MDR-TB is increasing in prevalence. However, as demonstrated with our case-report, the infrastructure to accurately diagnose MDR-TB is frequently lacking and the real extent of MDR-TB in East Africa at least, is unknown.
Written informed consent was obtained from the patient for publication of this case report.
The authors declare that they have no competing interests.
All authors contributed equally to the manuscript. All authors read andapproved the final manuscript.