Background: Data on the association between influenza and tuberculosis are limited. We describe the characteristics of\npatients with laboratory-confirmed tuberculosis, laboratory-confirmed influenza and tuberculosis-influenza co-infection.\nMethods: Patients hospitalized with severe respiratory illness (acute and chronic) were enrolled prospectively in four\nprovinces in South Africa. Naso/oropharyngeal specimens were tested for influenza virus by real time reverse\ntranscriptase polymerase chain reaction. Tuberculosis testing was conducted as part of clinical management.\nResults: From June 2010 through December 2011, 8032 patients were enrolled and influenza testing was conducted\non 7863 (98%). Influenza virus was detected in 765 (10%) patients. Among 2959 patients with tuberculosis and\ninfluenza results, 2227 (75%) were negative for both pathogens, 423 (14%) were positive for tuberculosis alone,\n275 (9%) were positive for influenza alone and 34 (1%) had influenza and tuberculosis co-infection. On multivariable\nanalysis amongst individuals with symptoms for ?7 days, tuberculosis influenza co-infection was associated with\nincreased risk of death, (adjusted relative risk ratio (aRRR) (6.1, 95% confidence interval (CI) 1.6-23.4), as compared\nto tuberculosis only infection. This association was not observed in individuals with symptoms for <7 days\n(aRRR.0.8, 95% CI 0.1-7.0).\nConclusion: Tuberculosis and influenza co-infection compared to tuberculosis single infection was associated with\nincreased risk of death in individuals with symptoms ?7 days. The potential public health impact of influenza\nvaccination among persons with laboratory-confirmed tuberculosis should be explored.
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