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Do sputum smear-negative TB suspects in a community with high HIV seroprevalence really have TB?

April 26, 2017high seroprevalence smear-negative sputum suspects TB

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Do sputum smear-negative TB suspects in a community with high HIV seroprevalence really have TB?

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OBJECTIVES: To estimate, within the context of a donor-supported National Tuberculosis Control Programme (NTBCP), the proportion of patients registered as sputum smear-negative pulmonary tuberculosis (TB) cases who have TB that can be confirmed on micriobiological criteria. DESIGN: Prospective assessment of randomly selected smear-negative TB cases who would, under programme conditions, have been registered for chemotherapy in Lilongwe, the capital of Malawi. Mycobacterial culture is not routinely available to inform diagnostic decision-making under NTBCP conditions. METHODS: Patients recruited to the study undergo rigorous clinical re-evaluation and investigation including repeat sputum submission, bronchoscopy and broncho-alveolar lavage (if repeat sputum smears are negative), and sputum submission post-bronchoscopy. All specimens proceed to routine smear microscopy and mycobacterial culture. RESULTS: Of 82 cases assessed, 23 (28%) were sputum smear-positive on retesting and 12 (15%)