ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2020. Global Tuberculosis Report 2020. Geneva, Switzerland: WHO.
-
2.
World Health Organization , 2020. Definitions and Reporting Framework for Tuberculosis—2013 Revision. Updated December 2014 and January 2020. Geneva, Switzerland: WHO.
-
3.
World Health Organization , 2022. Global Tuberculosis Case Notifications Dataset. Geneva, Switzerland: WHO.
-
4.
Abdullahi O , Moses N , Sanga D , Annie W , 2021. The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes. Sci Rep 11: 14854.
-
5.
Hargreaves N , Kadzakumanja O , Whitty C , Salaniponi F , Harries A , Squire S , 2001. ‘Smear-negative’ pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence. Int J Tuberc Lung Dis 5: 847–854.
-
6.
Teo AKJ , Singh SR , Prem K , Hsu LY , Yi S , 2021. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 22: 251.
-
7.
Lewinsohn DM , Leonard MK , LoBue PA , Cohn DL , Daley CL , Desmond E , Keane J , Lewinsohn DA , Loeffler AM , Mazurek GH , 2017. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 64: e1–e33.
-
8.
Matee M , Mtei L , Lounasvaara T , Wieland-Alter W , Waddell R , Lyimo J , Bakari M , Pallangyo K , Von Reyn CF , 2008. Sputum microscopy for the diagnosis of HIV-associated pulmonary tuberculosis in Tanzania. BMC Public Health 8: 68.
-
9.
Ling DI , Flores LL , Riley LW , Pai M , 2008. Commercial nucleic-acid amplification tests for diagnosis of pulmonary tuberculosis in respiratory specimens: meta-analysis and meta-regression. PLoS One 3: e1536.
-
10.
Bates M , Mudenda V , Shibemba A , Kaluwaji J , Tembo J , Kabwe M , Chimoga C , Chilukutu L , Chilufya M , Kapata N , 2015. Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study. Lancet Infect Dis 15: 544–551.
-
11.
Jayasooriya S , Dimambro-Denson F , Beecroft C , Balen J , Awokola B , Mitchell C , Kampmann B , Campbell F , Dodd P , Mortimer K , 2023. Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis. Thorax 78: 50–60.
-
12.
Oladele R , Irurhe N , Foden P , Akanmu A , Gbaja-Biamila T , Nwosu A , Ekundayo H , Ogunsola F , Richardson M , Denning D , 2017. Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis 21: 1056–1061.
-
13.
Lawn SD , 1999. Bronchiectasis: frequent misdiagnosis in sub-Saharan Africa. Trop Doct 29: 120–121.
-
14.
Lofgren SM et al., 2012. Histoplasmosis among hospitalized febrile patients in northern Tanzania. Trans R Soc Trop Med Hyg 106: 504–507.
-
15.
Hargreaves N , Kadzakumanja O , Phiri S , Lee C-H , Tang X , Salaniponi F , Harries A , Squire S , 2001. Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi. Trans R Soc Trop Med Hyg 95: 402–408.
-
16.
Bukundi EM , Mhimbira F , Kishimba R , Kondo Z , Moshiro C , 2021. Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: a retrospective cohort study. J Clin Tuberc Other Mycobact Dis 24: 100263.
-
17.
Association of Public Health Laboratories , 2018. Guidelines for Submission of Sputum Specimens for Tuberculosis Testing. Available at: https://stoptb.org/wg/gli/assets/documents/srt/APHL%20-%20Guidelines%20for%20Submission%20of%20Sputum%20Specimens%20for%20Tuberculosis%20Testing_April2018.pdf. Accessed March 19, 2022.
-
18.
Chew MY , Ng J , Lim TG , Lim TK , 2019. Diagnosing pulmonary tuberculosis by pooling induced sputum. J Clin Tuberc Other Mycobact Dis 11: 100100.
-
19.
Brown JS , 2012. Community-acquired pneumonia. Clin Med (Lond) 12: 538–543.
-
20.
McShane PJ , Naureckas ET , Tino G , Strek ME , 2013. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 188: 647–656.
-
21.
Klompas M , 2023. Lung Abscess in Adults. Available at: https://www.uptodate.com/contents/lung-abscess?search=lung%20abscess&source=search_result&selectedTitle=1~114&usage_type=default&display_rank=1. Accessed January 11, 2023.
-
22.
Menendez R , Cordero PJ , Santos M , Gobernado M , Marco V , 1997. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J 10: 1542–1546.
-
23.
Denning DW , Cadranel J , Beigelman-Aubry C , Ader F , Chakrabarti A , Blot S , Ullmann AJ , Dimopoulos G , Lange C , 2016. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47: 45–68.
-
24.
Jarvis JN , Harrison TS , 2008. Pulmonary cryptococcosis. Semin Respir Crit Care Med 29: 141–150.
-
25.
Hage CA et al., 2011. A multicenter evaluation of tests for diagnosis of histoplasmosis. Clin Infect Dis 53: 448–454.
-
26.
Travis WD et al., 2013. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188: 733–748.
-
27.
Hartung C , Lerer A , Anokwa Y , Tseng C , Brunette W , Borriello G , 2010. Open data kit: tools to build information services for developing regions. Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development. December 13–16, 2010, London, United Kingdom: Association for Computing Machinery, Article 18.
-
28.
Luo W , Lin Y , Li Z , Wang W , Shi Y , 2020. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med 20: 146.
-
29.
Gilpin C , Korobitsyn A , Migliori G , Raviglione M , Weyer K , 2018. The World Health Organization standards for tuberculosis care and management. Eur Respir J 51: 1800098.
-
30.
World Health Organization , 2016. Chest Radiography in Tuberculosis Detection: Summary of Current WHO Recommendations and Guidance on Programmatic Approaches. Geneva, Switzerland: WHO.
-
31.
National Tuberculosis and Leprosy Programme , 2013. Manual for the Management of Tuberculosis and Leprosy, 6th edition. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.
-
32.
Nightingale R et al., 2022. Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study. Thorax 77: 1131–1139.
-
33.
Swai HF , Mugusi FM , Mbwambo JK , 2011. Sputum smear negative pulmonary tuberculosis: sensitivity and specificity of diagnostic algorithm. BMC Res Notes 4: 475.
-
34.
McWilliams T , Wells A , Harrison A , Lindstrom S , Cameron R , Foskin E , 2002. Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis. Thorax 57: 1010–1014.
-
35.
Kang’ombe C , Harries A , Ito K , Clark T , Nyirenda T , Aldis W , Nunn P , Semba R , Salaniponi F , 2004. Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB. Int J Tuberc Lung Dis 8: 829–836.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1972 | 935 | 94 |
| Full Text Views | 165 | 76 | 0 |
| PDF Downloads | 78 | 41 | 0 |
Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania
Michael J. Maze
Michael J. Maze
Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand;
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Gissela Nyakunga
Gissela Nyakunga
Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
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Philoteus A. Sakasaka
Philoteus A. Sakasaka
Kilimanjaro Clinical Research Institute, Moshi, Tanzania;
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Kajiru G. Kilonzo
Kajiru G. Kilonzo
Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
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Elisha Luhwago
Elisha Luhwago
Mawenzi Regional Referral Hospital, Moshi, Tanzania;
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Manase Chelangwa
Manase Chelangwa
Ministry of Health and Social Welfare, Dodoma, Tanzania;
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John A. Crump
John A. Crump
Centre for International Health, University of Otago, Dunedin, New Zealand;
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Riziki M. Kisonga
Riziki M. Kisonga
Kibong’oto Infectious Disease Hospital, Kibong’oto, Tanzania;
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Deng B. Madut
Deng B. Madut
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;
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Josephine Rogath
Josephine Rogath
Mawenzi Regional Referral Hospital, Moshi, Tanzania;
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Adnan Sadiq
Adnan Sadiq
Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
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Rennae Thiessen
Rennae Thiessen
Radiology Department, Canterbury District Health Board, Christchurch, New Zealand
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Matthew P. Rubach
Matthew P. Rubach
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;
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ABSTRACT.
Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44–67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.
Author Notes
Financial support: This work was supported by the
Disclosure: The study was performed in accordance with the Declaration of Helsinki and all participants provided informed written consent. The study protocol was approved by the Kilimanjaro Christian Medical University College Research Ethics Committee (reference number 1155), the Tanzania National Institutes for Medical Research National Ethics Coordinating Committee (reference number NIMR/HQ/R.8c/Vol. I/1635), the University of Otago Human Ethics Committee (Health) (reference number H18/123), and the Duke University Institutional Review Board (Pro00103048).
Authors’ addresses: Michael J. Maze, Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand, E-mail: michael.maze@otago.ac.nz. Gissela Nyakunga, Kajiru G. Kilonzo, and Adnan Sadiq, Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mails: gisselanyakunga2021@gmail.com, mtundumliasi@googlemail.com, and adnan.radiologist@gmail.com. Philoteus A. Sakasaka, Kilimanjaro Clinical Research Institute, Moshi, Tanzania, E-mail: psakasaka@yahoo.com. Elisha Luhwago and Josephine Rogath, Mawenzi Regional Referral Hospital, Moshi, Tanzania, E-mails: elichaz90@gmail.com and phinerogath1@gmail.com. Manase Chelangwa, Ministry of Health and Social Welfare, Dodoma, Tanzania, E-mail: gchelangwa@gmail.com. John A. Crump, Centre for International Health, University of Otago, Dunedin, New Zealand, E-mail: john.crump@otago.ac.nz. Riziki M. Kisonga, Kibong’oto Infectious Disease Hospital, Kibong’oto, Tanzania, E-mail: kisongariziki@gmail.com. Deng B. Madut and Matthew P. Rubach, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, E-mails: deng.madut@duke.edu and matthew.rubach@duke.edu. Rennae Thiessen, Radiology Department, Canterbury District Health Board, Christchurch, New Zealand, E-mail: rennae.theissen@cdhb.health.nz.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2020. Global Tuberculosis Report 2020. Geneva, Switzerland: WHO.
-
2.
World Health Organization , 2020. Definitions and Reporting Framework for Tuberculosis—2013 Revision. Updated December 2014 and January 2020. Geneva, Switzerland: WHO.
-
3.
World Health Organization , 2022. Global Tuberculosis Case Notifications Dataset. Geneva, Switzerland: WHO.
-
4.
Abdullahi O , Moses N , Sanga D , Annie W , 2021. The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes. Sci Rep 11: 14854.
-
5.
Hargreaves N , Kadzakumanja O , Whitty C , Salaniponi F , Harries A , Squire S , 2001. ‘Smear-negative’ pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence. Int J Tuberc Lung Dis 5: 847–854.
-
6.
Teo AKJ , Singh SR , Prem K , Hsu LY , Yi S , 2021. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 22: 251.
-
7.
Lewinsohn DM , Leonard MK , LoBue PA , Cohn DL , Daley CL , Desmond E , Keane J , Lewinsohn DA , Loeffler AM , Mazurek GH , 2017. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 64: e1–e33.
-
8.
Matee M , Mtei L , Lounasvaara T , Wieland-Alter W , Waddell R , Lyimo J , Bakari M , Pallangyo K , Von Reyn CF , 2008. Sputum microscopy for the diagnosis of HIV-associated pulmonary tuberculosis in Tanzania. BMC Public Health 8: 68.
-
9.
Ling DI , Flores LL , Riley LW , Pai M , 2008. Commercial nucleic-acid amplification tests for diagnosis of pulmonary tuberculosis in respiratory specimens: meta-analysis and meta-regression. PLoS One 3: e1536.
-
10.
Bates M , Mudenda V , Shibemba A , Kaluwaji J , Tembo J , Kabwe M , Chimoga C , Chilukutu L , Chilufya M , Kapata N , 2015. Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study. Lancet Infect Dis 15: 544–551.
-
11.
Jayasooriya S , Dimambro-Denson F , Beecroft C , Balen J , Awokola B , Mitchell C , Kampmann B , Campbell F , Dodd P , Mortimer K , 2023. Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis. Thorax 78: 50–60.
-
12.
Oladele R , Irurhe N , Foden P , Akanmu A , Gbaja-Biamila T , Nwosu A , Ekundayo H , Ogunsola F , Richardson M , Denning D , 2017. Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians. Int J Tuberc Lung Dis 21: 1056–1061.
-
13.
Lawn SD , 1999. Bronchiectasis: frequent misdiagnosis in sub-Saharan Africa. Trop Doct 29: 120–121.
-
14.
Lofgren SM et al., 2012. Histoplasmosis among hospitalized febrile patients in northern Tanzania. Trans R Soc Trop Med Hyg 106: 504–507.
-
15.
Hargreaves N , Kadzakumanja O , Phiri S , Lee C-H , Tang X , Salaniponi F , Harries A , Squire S , 2001. Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi. Trans R Soc Trop Med Hyg 95: 402–408.
-
16.
Bukundi EM , Mhimbira F , Kishimba R , Kondo Z , Moshiro C , 2021. Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: a retrospective cohort study. J Clin Tuberc Other Mycobact Dis 24: 100263.
-
17.
Association of Public Health Laboratories , 2018. Guidelines for Submission of Sputum Specimens for Tuberculosis Testing. Available at: https://stoptb.org/wg/gli/assets/documents/srt/APHL%20-%20Guidelines%20for%20Submission%20of%20Sputum%20Specimens%20for%20Tuberculosis%20Testing_April2018.pdf. Accessed March 19, 2022.
-
18.
Chew MY , Ng J , Lim TG , Lim TK , 2019. Diagnosing pulmonary tuberculosis by pooling induced sputum. J Clin Tuberc Other Mycobact Dis 11: 100100.
-
19.
Brown JS , 2012. Community-acquired pneumonia. Clin Med (Lond) 12: 538–543.
-
20.
McShane PJ , Naureckas ET , Tino G , Strek ME , 2013. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 188: 647–656.
-
21.
Klompas M , 2023. Lung Abscess in Adults. Available at: https://www.uptodate.com/contents/lung-abscess?search=lung%20abscess&source=search_result&selectedTitle=1~114&usage_type=default&display_rank=1. Accessed January 11, 2023.
-
22.
Menendez R , Cordero PJ , Santos M , Gobernado M , Marco V , 1997. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J 10: 1542–1546.
-
23.
Denning DW , Cadranel J , Beigelman-Aubry C , Ader F , Chakrabarti A , Blot S , Ullmann AJ , Dimopoulos G , Lange C , 2016. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47: 45–68.
-
24.
Jarvis JN , Harrison TS , 2008. Pulmonary cryptococcosis. Semin Respir Crit Care Med 29: 141–150.
-
25.
Hage CA et al., 2011. A multicenter evaluation of tests for diagnosis of histoplasmosis. Clin Infect Dis 53: 448–454.
-
26.
Travis WD et al., 2013. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188: 733–748.
-
27.
Hartung C , Lerer A , Anokwa Y , Tseng C , Brunette W , Borriello G , 2010. Open data kit: tools to build information services for developing regions. Proceedings of the 4th ACM/IEEE International Conference on Information and Communication Technologies and Development. December 13–16, 2010, London, United Kingdom: Association for Computing Machinery, Article 18.
-
28.
Luo W , Lin Y , Li Z , Wang W , Shi Y , 2020. Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis. BMC Pulm Med 20: 146.
-
29.
Gilpin C , Korobitsyn A , Migliori G , Raviglione M , Weyer K , 2018. The World Health Organization standards for tuberculosis care and management. Eur Respir J 51: 1800098.
-
30.
World Health Organization , 2016. Chest Radiography in Tuberculosis Detection: Summary of Current WHO Recommendations and Guidance on Programmatic Approaches. Geneva, Switzerland: WHO.
-
31.
National Tuberculosis and Leprosy Programme , 2013. Manual for the Management of Tuberculosis and Leprosy, 6th edition. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.
-
32.
Nightingale R et al., 2022. Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study. Thorax 77: 1131–1139.
-
33.
Swai HF , Mugusi FM , Mbwambo JK , 2011. Sputum smear negative pulmonary tuberculosis: sensitivity and specificity of diagnostic algorithm. BMC Res Notes 4: 475.
-
34.
McWilliams T , Wells A , Harrison A , Lindstrom S , Cameron R , Foskin E , 2002. Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis. Thorax 57: 1010–1014.
-
35.
Kang’ombe C , Harries A , Ito K , Clark T , Nyirenda T , Aldis W , Nunn P , Semba R , Salaniponi F , 2004. Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB. Int J Tuberc Lung Dis 8: 829–836.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1972 | 935 | 94 |
| Full Text Views | 165 | 76 | 0 |
| PDF Downloads | 78 | 41 | 0 |