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

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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.

Keywords: ACF; EDs; screening; tuberculosis

Document Type: Research Article

Affiliations: 1: Hospital Nacional Dos de Mayo, Lima, Peru, Universidad Nacional Mayor de San Marcos, Lima, Peru 2: Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA 3: Hospital Nacional Dos de Mayo, Lima, Peru 4: Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA, Medicine Service, Infectious Disease Section, Albuquerque VA Medical Center, Albuquerque, NM, USA

Publication date: March 1, 2023

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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