Pulmonary tuberculosis in Tanzania Clinical Presentation, Complications and problems of Management

While there have been several reports on the epidemically and chemotherapy of tuberculosis in Tanzania, few have death with clinical aspects of disease. The aim of this report to therefore, been to outline the clinical presentation short-term complications and problems encountered in the management of tuberculosis in Muhimbili medical centre. The patients medical could be regarded as representative of the whole country on they did not come only from the city of Dar es salaam but from all over Tanzania. Ninety eight patients with pulmonary tuberculosis were studied fourth six were male and 52 were female. Their ages ranged from 8-84 years (mean (33.4years) four percent of the patients were in the primary school age group, 80% were in productive age group and 8% were in the old age group . eight percent of patients studied did not know their ages. Tuberculosis, therefore, in Tanzania affects mainly the productive age group. The commonest symptoms in order of frequency were enough haemoptysis, loss of weight, chest pain, fever on and off dyopnoea (on exertion), night sweats, evening fever, and loss of appetite, malaise and general body weakness. With the exception of haemoptysis about 65% of the patients present to hospital between 3-12 weeks after the onset of symptoms. The majority of patients with haemoptysis present between 1-21days. Thirdly seven patients were anaemic ( i..e had a hemoglobin of less than 10g/dl). Twenty seven of these had microcytic hypochromic anaemia, 7 had normocytic normochromic anaemia, two had mucrocytic hypochromic anaemia and one had normocytic hypochromic anaemia. Hookworm infestation was present in 1/3 of patients with microcytic hypochromic anaemia. The mean serum iron was 91.8 ug/dl males and 81.3 for female patient. Mean T.I.B.C was 296.4 ug/dl for male and 313.2ug/dl for female patients. Analysis of the serum iron and total iron binding capacity suggest that iron should not be given routinely to all tuberculosis patients but each patient should be assessed separately. Radiological examination showed that pulmonary tuberculosis affects the right lung more commonly than the left. Right upper zone involvement was found in 53% of the patients. Radiology should not be used for diagnostic purposes-it should be to assess the extent of the disease and progress. Also it should augment the other laboratory investigation in the diagnosis of tuberculosis. Sensitivity results showed that primary drug resistance to first line drugs is not a major problem and there has not been much change sice the study done by the East Africa/British medical research council(Tanzania) tuberculosis survey (1975). Our patients had 6.8% resistance to isoniazid and streptomycin and 4.1% resistance to isoniazid alone. It is therefore recommended that the present first line drugs should continue to be used. No patient had atypical mycobacterium of the 59 patients with diabetes mellitus screened for tuberculosis 10(16.9%) were found to have either active tuberculosis or a history of tuberculosis in the past, of the 20 tuberculosis patients with no history of diabetes mellitus who haad Glucose tolerance test done two (10.0) were found to have abnormal carbohydrate tolerance with 2 hour post prandiol blood sugers above 140mgm%. While the high incidence of tuberculosis amongst diabeters mellitus patients has been confirmed in this study, it is uncertain whether patients with tuberculosis have a higher incidence of abnormal carbohydrate intolerance than the general population. It is suggested further research should be done, hemoptysis was the commonest complication encountered. Thirty nine (39.8)0 patients had hemoptysis, (of these 16 had severe hemoptysis). Other complication encountered were exfoliative dermaties due to anti- tuberculous drugs in four patients ( 4.1). three patients had massive fibrosis and there was one patient with each of the following complication empyema, pneumothorax and pyopneumothax. It is suggested that our primary health care units should be taught to deal with hemoptysis and exfoliative dermatitis and any other minors complications that may a rise during periods of treatments. Selected hospital (s) should be equipped to deal with major complication. There were 8 defaulters, high lighting the need for medical personnel to be more open in explaining the disease and the necessity to continue treatment to their patients.