Active case-finding of pulmonary TB in an urban emergency department

BACKGROUND: The WHO recommends systematic screening of TB in high TB prevalence settings. We evaluated an active case-finding strategy using sputum screening regardless of symptoms in a high TB prevalence Emergency Department (ED) in Peru.

METHODS: This was a cross-sectional study conducted at the Hospital Nacional Dos de Mayo ED, which serves low-income populations in downtown Lima, Peru. Adults presenting to the ED for any reason and able to provide sputum were enrolled. Participants provided one sputum specimen for acid-fast bacilli smear and culture. A second sputum specimen for Xpert^® MTB/RIF testing was collected if the patient was admitted to an ED observation unit.

RESULTS: Between September 2017 and March 2018, 5,171 individuals who presented to the ED were approached. Of 2,119 individuals able to provide sputum, 78 (3.7%) participants had a positive culture and/or Xpert result and were newly diagnosed with TB, whereas traditional screening using >2-week cough identified 41 (1.9%) cases (3.7% vs. 1.9%; P < 0.001). Twelve TB cases (15.4%) reported no TB symptoms of any duration.

CONCLUSION: ED-based active case-finding of pulmonary TB using symptom-neutral sputum screening increased TB identification compared to traditional symptom-based screening. Our results align with current WHO recommendation of systematic screening in high TB prevalence areas, which may include ED settings.