University of Dar es Salaam School of Health Sciences

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Browsing University of Dar es Salaam School of Health Sciences by Author "Aris, Eric Aristarco"

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    Diagnostic criteria in sputum smear negative tuberculosis patients admitted to the medical wards in Muhimbili medical centre Dar es Salaam, Tanzania
    (University of Dar es Salaam, 1995) Aris, Eric Aristarco
    A prospective study involving 178 patients was conducted at the Muhimbili medical Centre ( MMC) between 1st November 1994 and March 1995inclusive to establish diagnostic criteria for tuberculosis in patients with negative sputum smear for acid alcohol fast bacilli ( AAFB). Patients presenting with productive cough for at least two weeks with or without hemoptysis, chest pain, and fever or weight loss were enrolled in the study. In 90 (50.6%) patients, AAFB could be isolated in specimen other than the sputum. By using univariate analysis, of all the symptoms, signs and laboratory features investigated, cough of four or more weeks, hemoptysis, dyspnoea, oral candidiasis, herpes zoster, pulse rate, chest consolidation, pleural effusion, midzone and upper zone chest x-ray opacities were significantly different between the sputum AAFB negative tuberculosis and non-tuberculosis patients ( p<0.05). Other features included percent neutrophil count, eosinophil count, Lymphocyte count and total serum proteins. On discriminant analysis, only the mantoux reaction, pleural effusion, kaposis lesion, cervical lymphadenopathy, matted lymph node, midzone and upper zone chest x ray infiltrates were discriminating among smear negative tuberculosis and non-tuberculosis patients. Taken together these features could classify correctly 84.1% of sputum AAFB negative patients into either tuberculosis or not tuberculosis. In sputum smear negative patients severely ill as the ones in the present study, there are no symptoms, signs or simple laboratory features either alone or in combination that are accurate in the diagnosis of tuberculosis. A therapeutic trial may be the only armamentarium in the management of the sputum smear AAFB negative patient suspected of having tuberculosis. In view of the many tuberculosis patient sputum smear AAFB negative, the search for other diagnostic tests for tuberculosis should be intensified.