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Free Content Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia

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SETTING: Four clinics in The Gambia.

OBJECTIVE: To document clinical and radiographic presentations of sputum smear-positive tuberculosis in adults.

DESIGN: Newly diagnosed acid-fast bacilli (AFB) smear, culture-positive tuberculosis patients aged ≥15 years were interviewed and examined, and underwent tuberculin skin testing, HIV testing and chest X-ray reviewed by a chest physician using set criteria.

RESULTS: Of 340 patients enrolled (median age 29 years; males 73%), 8.3% were HIV-positive. One-third reported haemoptysis, >90% reported weight loss and fever, and wasting was the most common sign (69%). Crepitations were the most frequent auscultatory finding (41%). The most common radiological lesion was a patchy infiltrate (>90%). Cavitation was present in 206 patients (60.6%), most frequently occurred in the upper lung fields, was associated with increasing bacterial load in the sputum, and was less prevalent in HIV-positive patients (45% vs. 62%; P = 0.07). Auscultatory and chest X-ray findings matched only one-third of the time.

CONCLUSION: In our setting, wasting is the most common clinical sign of sputum smear-positive tuberculosis. Auscultatory findings correlate poorly with radiological abnormalities. Cavitation is associated with increasing bacterial load in the sputum, and is therefore a strong indicator for early treatment.
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Keywords: HIV/TB co-infection; The Gambia; chest X-ray; clinical findings; tuberculosis

Document Type: Regular Paper

Affiliations: 1: University of Minnesota, Department of Medicine, Minneapolis, Minnesota, USA 2: Medical Research Council Labs, Department of Tuberculosis, Fajara, Banjul, The Gambia 3: University of California, Department of Medicine, San Francisco, California, USA

Publication date: 2003-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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