The Prevalence of Disseminated Tuberculosis Among Tuberculosis Patients in Uganda

Abstract Background: The incidence of disseminated tuberculosis (DTB) is increasing worldwide yet its epidemiological characteristics in Uganda are not known. The purpose of this study was to determine the prevalence, associated factors, and treatment outcomes of DTB among patients at a national tuberculosis (TB) treatment center in Uganda.Methodology: The study took place at the TB unit of Mulago National Referral Hospital in Kampala, Uganda. We conducted a retrospective chart review of TB patients who were enrolled in care between January 2015 and December 2019. Eligible charts were for patients with pulmonary bacteriologically confirmed TB enrolled into care in the period under study. DTB was defined as TB at two or more non-contiguous sites.Results: Overall, 400 patient charts were eligible, of whom 240(60.0%) were aged 15 – 34 years and 205 (51.3%) were female. The prevalence of DTB was 8.5% (34/400) (95% CI: 6.0% – 11.7%). Patients with DTB were more likely to be casual laborers (44.1% vs 21.3%, p = 0.023), from Bantu ethnic group (67.7% vs. 40.5%, p = 0.0021), and had at least one comorbidity (82.4% vs 37.2%, p <0.001), of which HIV was the most frequent. Further, patients with DTB (n = 20) were more likely to have empyema (15% vs 2.6%, p = 028) but less likely to have bronchopneumonic opacification (0.0% vs 15.3%, p = 0.043) on chest x-ray imaging. Patients with DTB had higher mortality (26.5% vs 6.37%) and a lower cure rate (41.2% vs 64.8%), p = 0.002.Conclusion: Our findings highlight the need for early detection of TB before dissemination and greater use of TB preventive therapies in HIV-infected individuals to counter the observed high mortality of DTB.