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The diagnosis of pulmonary tuberculosis (TB) is challenging among patients infected with HIV. This study aimed to assess the incremental yield of bronchoalveolar lavage (BAL) and postbronchoscopy sputum (PBS) in the diagnosis of pulmonary TB among HIV-infected patients whose sputum smear microscopy was negative for TB or who were unable to produce sputum for analysis. The study was a prospective study conducted between March 2013 and December 2014 and all patients willing to participate were recruited. They underwent bronchoscopy and bronchoalveolar lavage and when possible a sample of postbronchoscopy sputum was taken within 5 days after the bronchoscopy. Of the 115 HIV-infected patients who underwent bronchoscopy, pulmonary TB was diagnosed in 56 (48.6%) patients. Among 56 patients confirmed with positive cultures, 34/56 (57.1%) were positive both in PBS and BAL, 13/56 (23.2 %) cultures were positive only in PBS and 9/56 (16%) were positive only in BAL. The culture yield of Mycobacterium tuberculosis was increased by 12% using PBS samples and by 7.8% using BAL. The difference between BAL and PBS was not statistically significant. The study concluded that BAL and PBS are very useful methods in the diagnosis of pulmonary TB among HIV-infected patients who are smear negative or have dry cough. Strengthening bronchoscopy can reduced empirical treatment of TB especially among HIV patients. [ABSTRACT FROM AUTHOR]

Background: Leptospirosis is a zoonotic disease transmitted through the urine of wild and domestic animals, and is responsible for over 50,000 deaths each year. In East Africa, prevalence varies greatly, from as low as 7% in Kenya to 37% in Somalia. Transmission epidemiology also varies around the world, with research in Nicaragua showing that rodents are the most clinically important, while studies in Egypt and Chile suggest that dogs may play a more important role. There are no published studies of leptospirosis in Rwanda., Methods & Findings: We performed a cross-sectional survey of asymptomatic adults recruited from five occupational categories. Serum samples were tested using ELISA and Microscopic Agglutination Test (MAT). We found that 40.1% (151/377) of asymptomatic adults had been exposed to Leptospira spp. Almost 36.3% of positive subjects reported contact with rats (137/377) which represent 90.7% among positive leptospira serology compared with 48.2% of negative subjects (182/377) which represent 80.5% among negative leptospira serology (OR 2.37, CI 1.25-4.49) and 1.7 fold on prevalence ratio and 2.37 of odd ratio. Furthermore, being a crop farmer was significantly associated with leptospirosis (OR 2.06, CI 1.29-3.28). We identified 6 asymptomatic subjects (1.6%) who met criteria for acute infection., Conclusions: This study demonstrates a high prevalence of leptospiral antibodies infection among asymptomatic adults in rural Rwanda, particularly relative to neighboring countries. Although positive subjects were more likely to report rat contact, we found no independent association between rats and leptospirosis infection. Nonetheless, exposure was high among crop farmers, which is supportive of the hypothesis that rats together with domestic livestock might contribute to the transmission. Further studies are needed to understand infecting Leptospira servers and elucidate the transmission epidemiology in Rwanda and identify means of host transmitters., Competing Interests: The authors have declared that no competing interests exist.