Prevalence of pulmonary tuberculosis and comparative evaluation of screening strategies in a Brazilian prison
Abstract:SETTING: A prison (1171 male inmates) in Rio de Janeiro, Brazil.
OBJECTIVES: To determine the prevalence of active pulmonary tuberculosis (TB) and to assess the performance of several screening strategies.
DESIGN: In a cross-sectional study, all inmates underwent chest radiographic screening. Subjects with abnormal findings underwent sputum smear examination and sputum culture. Taking this strategy as the reference, we assessed three targeted screening strategies to identify TB suspects: Strategy 1: cough >3 weeks; Strategy 2: WHO score ≥5; Strategy 3: presence of at least one potentially TB-related symptom.
RESULTS: The prevalence of TB cases was 4.6% (48/1052) and 2.7% for definite TB cases. If TB suspects identified by targeted screening had sputum smear examination alone, 37 (86.0%) of the 43 cases would have been missed by Strategy 1, 34/43 (79.1%) by Strategy 2 and 34/43 (79.1%) by Strategy 3. If TB suspects had both sputum smear examination and, for smear-negative subjects, chest radiography, respectively 28/43 (65.1%), 18/43 (41.9%) and 13/43 (30.2%) of cases would have been missed.
CONCLUSION: All three targeted screening strategies were unreliable. Given the importance of early TB diagnosis in overcrowded and highly endemic settings, routine radiography-based screening may be warranted.
Document Type: Regular Paper
Affiliations: 1: Supertintendencia de Saúde, Secretaria de Administração Penitenciária do Estado do Rio de Janeiro, Rio de Janeiro, Brazil 2: Fundação Athaulfo de Paiva, Rio de Janeiro, Brazil 3: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil 4: Disciplina de Pneumologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; and Serviço de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 5: Serviço de Laboratório, Centro de Referencia Professor Helio Fraga, Rio de Janeiro, Rio de Janeiro State, Brazil 6: INSERM U707, Université Pierre et Marie Curie, Paris VI, Paris, France
Publication date: June 1, 2005
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