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Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults.

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dc.contributor Médecins Sans Frontières, Cape Town, South Africa.
dc.creator Saranchuk, P
dc.creator Boulle, A
dc.creator Hilderbrand, K
dc.creator Coetzee, D
dc.creator Bedelu, M
dc.creator Van Cutsem, G
dc.creator Meintjes, G
dc.date 2007-07
dc.date.accessioned 2017-01-31T07:09:58Z
dc.date.available 2017-01-31T07:09:58Z
dc.identifier Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults. 2007, 97 (7):517-23 S. Afr. Med. J.
dc.identifier 0256-9574
dc.identifier 17805454
dc.identifier http://hdl.handle.net/10144/18372
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/18372
dc.identifier South African Medical Journal
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/18372
dc.description OBJECTIVES: To evaluate the diagnostic accuracy of and reduction in diagnostic delay attributable to a clinical algorithm used for the diagnosis of smear-negative pulmonary tuberculosis (SNPTB) in HIV-infected adults. DESIGN: An algorithm was designed to facilitate clinicoradiological diagnosis of pulmonary TB (PTB) in HIV-infected smear-negative adult patients. A folder review was performed on the first 58 cases referred for empirical TB treatment using this algorithm. SETTING: Nolungile HIV Clinic, Site C, Khayelitsha. SUBJECTS: Subjects included 58 HIV-infected adult patients with suspected PTB consecutively referred to the local TB clinic for outpatient TB treatment using this algorithm between 12 February 2004 and 30 April 2005. OUTCOME MEASURES: Outcome measures were response of C-reactive protein, haemoglobin, weight and symptoms to TB treatment, and TB culture result. Diagnostic delay (in days) was calculated. RESULTS: Thirty-two of the 58 patients (55%) had positive TB cultures (definite TB). Initiation of TB treatment occurred on average 19.5 days before the positive culture report. A further 21 patients (36%) demonstrated clinical improvement on empirical treatment (probable/possible TB). Two patients did not improve and subsequently died without a definitive diagnosis. Three patients defaulted treatment. CONCLUSIONS: SNPTB is more common in HIV-infected patients and leads to diagnostic delay. This algorithm allowed for earlier initiation of TB treatment in HIV-infected patients presenting with symptoms of PTB and negative smears or nonproductive cough in a high TB incidence setting.
dc.language en
dc.publisher Health and Medical Publishing Group
dc.relation http://www.samj.org.za
dc.rights Archived on this site with kind permission of the Health and Medical Publishing Group and the South African Medical Association.
dc.title Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults.


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