Alternate diagnosis in clinically diagnosed pulmonary tuberculosis patients treated at tertiary care hospital in a high TB burden country

Irfan, Muhammad; Zahid, Aqusa; Vaqar, Maham; Sharif, Ayesha; Jabeen, Kauser; Zubairi, Ali Bin Sarwar

doi:10.1183/13993003.congress-2020.514

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“…Clinical signs and symptoms and chest imaging findings remain the main PTB diagnostic tools for those PTB patients who are negative for sputum AFB or GeneXpert test [5,6]. However, the nonspecificity of both clinical and chest imaging findings for PTB may often lead to incorrect diagnosis and result in inappropriate or delayed therapy [7][8][9][10]. Smear negative PTB remains less well studied, particularly in the current context in Ethiopia.…”

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confidence: 99%

Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study

Alemayehu,

Wassie,

Neway

et al. 2024

Pulmonary Medicine

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Background. Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Results. Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Conclusions. Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia.

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