Abstract / Summary
Background: Clinical data may not accurately diagnose pulmonary tuberculosis (PTB), mainly due to manifestation overlap with other diseases, causing delays and misdiagnoses. Many gaps in the interpretation of clinical and radiographic findings were addressed and updated in our study.
Methods: An institutional-based study was carried out between 02/01/2018 and 26/06/2020 to clinically assess TB outpatients in high-burden zones. Those patients were identified through smear microscopy, GeneXpert Ultra, and chest X-rays and TB positives were interviewed. Of total, 329 patients were enrolled from Bench-Skeko, 23 from Skeka, and 29 from Keffa. Both descriptive and inferential statistics were performed using Stata 14/16.
Results: A total of 410 TB confirmed cases, with 328 (80%) being PTB, 79 (19.3%) EPTB, and 3 (0.73%) involving both forms were involved in this study. The mean age was 27.65 ± 11.44 years, with 55% male. Most patients were recently identified (99.3%). GeneXpert was used in 62.4%, AFB in 8.78%, and lesion biopsy or FNAC for EPTB in 16.83%, and 98% was on the intensive therapy for susceptible TB. A febrile episode was diagnosed in 93% (5.4% >40°C, 87% < 39°C), night sweat in 93.17%, appetite loss in 89%, fatigue in 90%, and weight loss in 88%. Respiratory symptoms were very common, with cough reported in 94.2%: productive in 91%, and prolonged (>3 wks) in 77%. Abnormalities in chest X ray were reported in 16.3%, with pleural effusion in 11.2%, cavitary formations in 13%, and lymph node enlarged in 14%. Blood pressure abnormalities were relatively low, with 76.3% having normal. Only few findings were reported as statistically significant predictors of active PTB. Chest abnormalities (OR=6.87), prolonged cough (OR=6.4), mucoid (OR=14.6), and mucopurulent sputum (OR=56.4) increased PTB odds, while lymphadenopathy was less commonly reported (OR=0.16). Appetite loss (OR=3.26), pleural effusion (OR=2.41), and fibrosis (OR=2.31) showed weak associations.
Conclusions: A high prevalence of the TB tetrad: prolonged cough, night sweat, fever and appetite loss were observed. PTB odds were higher with chest abnormalities, effusion, fibrosis, infiltration, and expansion, highlighting the diagnostic value of radiology.