IngentaConnect Clinical diagnosis of smear-negative pulmonary tuberculosis: an a...

Authors: Harries A. D.¹; Hargreaves N. J.²; Kwanjana J. H.¹; Salaniponi F. M.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 5, Number 12, December 2001 , pp. 1143-1147(5)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Thirty-seven hospitals in Malawi.

OBJECTIVE: To audit the hospital practice of clinically diagnosing adults with smear-negative pulmonary tuberculosis (PTB).

DESIGN: A cross-sectional survey of adults aged 15 years or above who were registered and receiving in-patient treatment for smear-negative PTB. An assessment of each patient was carried out to determine 1) the number of recommended diagnostic guidelines (cough >3 weeks, no response to antibiotics, negative sputum smears and a chest radiograph compatible with PTB) used by hospital staff in making the diagnosis of PTB, and 2) whether the clinical diagnosis of smear-negative PTB was correct according to criteria set by the study.

RESULTS: There were 259 patients, 127 men and 132 women, with a mean age of 37 years; 93% had a cough >3 weeks, 95% had received one or more courses of antibiotics, 92% had submitted sputum samples for smear examination and 97% had chest radiographs performed. In 148 (57%) patients, all four diagnostic guidelines were used, and in 238 (92%) patients three or more were used. The diagnosis of smear-negative PTB was considered correct by study criteria in 203 (78%) patients. In the remainder, 22 (8%) were considered to have extra-pulmonary TB and 34 (14%) another diagnosis.

CONCLUSION: Hospital practices in the diagnosis of smear-negative PTB are reasonable, although there is room for improvement with in-service training and regular audits of practice.

Keywords: smear-negative pulmonary tuberculosis; diagnosis

Language: English

Document Type: Regular paper

Affiliations: 1: National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi 2: National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi and Liverpool School of Tropical Medicine, Liverpool, UK

Clinical diagnosis of smear-negative pulmonary tuberculosis: an audit of diagnostic practice in hospitals in Malawi