Clinical and radiological presentation of 340 adults with smear-positive tuberculosis 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.
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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