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Free Content Enhanced tuberculosis identification through 1-month follow-up of smear-negative tuberculosis suspects

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SETTING: Bandim Health Project, Bissau, Guinea-Bissau.

OBJECTIVE: To conduct tuberculosis (TB) screening among former TB suspects in whom TB had been ruled out on initial consultation and therefore assumed to be TB-negative (aTBneg).

DESIGN: In a cohort follow-up study, ‘aTBneg suspects’ were screened for symptoms from 1 month after the initial negative sputum smear examination. Symptomatic individuals were referred for clinical re-examination and human immunodeficiency virus (HIV) testing.

RESULTS: Among 428 TB suspects presenting over a 10-month period in 2007, 80% (343) were smear-negative. Of these, 21 were subsequently diagnosed with smear-negative TB. Of the remaining 322 aTBneg patients, 212 were followed up and symptoms were examined ≥1 month after initial examination. Among followed up patients, 89 (42%) were still symptomatic: five were diagnosed with TB on the basis of repeated sputum smears and chest X-ray. Of 44 symptomatic patients, 39% (n = 17) were HIV-infected. Thirteen (4%) of the 322 aTBneg suspects died before follow-up.

CONCLUSION: A large proportion of aTBneg patients remained symptomatic after 1 month. Several TB cases had initially not been diagnosed, and HIV infection was highly prevalent. aTBneg suspects have a high mortality rate and need increased attention from both TB and HIV programmes.

Keywords: Guinea-Bissau; HIV; active case finding; tuberculosis suspects

Document Type: Regular Paper


Affiliations: 1: Bandim Health Project, INDEPTH Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), Bissau, Guinea-Bissau 2: Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark 3: Bandim Health Project, INDEPTH Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), Bissau, Guinea-Bissau; and Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark

Publication date: April 1, 2011

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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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