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    Jan 17, 2021
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    Evaluation of a diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV-infected adults.

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    Authors
    Saranchuk, P
    Boulle, A
    Hilderbrand, K
    Coetzee, D
    Bedelu, M
    Van Cutsem, G
    Meintjes, G
    Affiliation
    Médecins Sans Frontières, Cape Town, South Africa.
    Issue Date
    2007-07
    
    Metadata
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    Journal
    South African Medical Journal
    Abstract
    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.
    Publisher
    Health and Medical Publishing Group
    URI
    http://hdl.handle.net/10144/18372
    PubMed ID
    17805454
    Additional Links
    http://www.samj.org.za
    Language
    en
    ISSN
    0256-9574
    Collections
    TB

    entitlement

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