Chronic Cough in Primary Health Care Attendees, Harare, Zimbabwe: Diagnosis and Impact of HIV Infection

Background. Cough lasting for 3 weeks (i.e., chronic cough) indicates that a patient has suspected tuber-culosis (TB). At the primary health care level, the spectrum of disease that causes chronic cough has not been previously investigated in a setting with a high prevalence of human immunodeficiency virus (HIV) infection. Methods. A total of 544 adults with chronic cough were recruited systematically from 2 primary health care clinics, and they were evaluated using preset first- and second-line investigations and diagnostic case definitions. Results. The overall prevalence of HIV infection among the study cohort was 83%. TB was the most common diagnosis, with 207 HIV-positive patients (46%) and 27 HIV-negative patients (30%) having confirmed or probable TB. Of these, 145 HIV-positive patients with TB (70%) and 20 HIV-negative patients with TB (74%) had smear-positive cases of TB. Only 17 HIV-positive and 2 HIV-negative patients had smear-negative but culture-positive cases of TB. Lower respiratory tract infections ( ; HIV prevalence, 79%) and pneumonia ( ; HIVnp 178 np 87 prevalence, 89%) were the next most common diagnoses. Asthma ( ; HIV prevalence, 46%), posttuberculousnp 26 disease and other fibrotic lung disease ( ; HIV prevalence, 88%), and cardiac disease ( ; HIV prevalence,np 34 np 15 93%) were more common than were Pneumocystis jiroveci pneumonia and cryptococcosis ( and,np 8 np 5 respectively; HIV prevalence, 100%), and we found no cases of nocardiosis or histoplasmosis. Conclusions. TB was diagnosed for 43 % of patients who presented with chronic cough to primary healt