# High two-month mortality in Gabonese adults with and without tuberculosis: A prospective cohort study of patients with presumed pulmonary tuberculosis

## TL;DR

A study in Gabon found that over 10% of hospitalized adults with suspected tuberculosis died within two months, regardless of whether they actually had tuberculosis.

## Contribution

The study reveals high mortality rates in presumed tuberculosis cases, independent of TB status, and identifies risk factors like HIV and low socioeconomic status.

## Key findings

- Two-month mortality exceeded 10% in hospitalized adults with presumed tuberculosis.
- Most non-TB cases showed bacterial or malignant patterns on chest X-ray.
- HIV infection, low socioeconomic status, and rural residence were linked to death.

## Abstract

•Two-month mortality exceeded 10% in hospitalized adults with presumed tuberculosis.•Mortality was independent from whether tuberculosis was present or not.•HIV infection, low socioeconomic status, and rural residence were linked to death.•Most non-TB cases showed bacterial or malignant patterns on chest X-ray.•Algorithms after negative TB tests need to be improved for better patient outcomes.

Two-month mortality exceeded 10% in hospitalized adults with presumed tuberculosis.

Mortality was independent from whether tuberculosis was present or not.

HIV infection, low socioeconomic status, and rural residence were linked to death.

Most non-TB cases showed bacterial or malignant patterns on chest X-ray.

Algorithms after negative TB tests need to be improved for better patient outcomes.

Pulmonary tuberculosis (PTB) remains a leading cause of mortality in sub-Saharan Africa but often remains unconfirmed. Patient outcomes in unconfirmed TB or non-TB cases are rarely studied. We assessed 2-month outcomes and associated factors in presumed TB cases independent of TB status.

Hospitalized adults with presumed PTB in Lambaréné, Gabon, were prospectively enrolled (September 2024-January 2025). Demographic data, including a socioeconomic status (SES) score, were collected. Laboratory analyses included HIV-test, GeneXpert and mycobacterial culture. Chest X-rays (CXR) were assessed for signs of TB and non-TB conditions. Diagnoses were categorized as confirmed PTB, clinically diagnosed PTB, or non-TB. Two-month follow-up assessed outcomes.

Of 103 participants, 30 of 102 (29%) were HIV positive. Median age was 44 years (interquartile range 28-57). PTB was confirmed in 34 of 103 (33%), clinically diagnosed in 5 of 103 (5%), and not diagnosed in 62 of 103 (62%). In the non-TB group, CXR findings were consistent with bacterial pneumonia (24/62, 39%) or malignancy (12/62, 19%). At follow-up, 81 of 100 (81%) reported improvement, whereas 19 of 100 (19%) did not, including 12 of 100 (12%) deaths. HIV infection, smoking, alcohol use, rural residence, and lower SES were associated with death, no difference was seen by TB status.

High 2-month mortality, regardless of final TB status, highlights the need for improved access to diagnostics and better treatment algorithms in severe respiratory illness.

German Clinical Trials Register (DRKS00034074).