How good are systemic symptoms and blood inflammatory markers at detecting individuals with tuberculosis?
SETTING: The diagnosis of tuberculosis (TB) may be rejected in the absence of symptoms such as fever, sweats or weight loss. OBJECTIVES: To determine how frequently these features and blood test evidence of inflammation were absent in individuals with TB. METHODS: Prospective cohort study of 175 unselected subjects diagnosed with TB at a UK TB service between 2003 and 2006. RESULTS: Eight (5%) subjects identified by screening and 24 (14%) without culture confirmation were excluded. Of the remaining 143, fever, sweats or weight loss were absent in respectively 37%, 39% and 38%. All three symptoms were absent in 25%. In 88 subjects with pulmonary disease, all three symptoms were absent in 20% (10% of smear-positive cases). Overall, C-reactive protein was normal in 15%, erythrocyte sedimentation rate in 21% and lactate dehydrogenase in 55%. In a multivariable model, factors associated with absent symptoms included drug-resistant TB (adjusted odds ratio [aOR] 3.58, P = 0.004) and female se
