Comparison of symptoms and treatment outcomes between actively and passively detected tuberculosis cases: the additional value of active case finding

Passive detection of tuberculosis (TB) cases may lead to delay in treatment which may contribute to increased severity of disease and mortality. Active case finding may be an alternative. In a community survey in Cape Town, South Africa, we actively detected 27 bacteriologically positive TB cases an...

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Bibliographic Details
Published in:Epidemiology and infection Vol. 136; no. 10; pp. 1342 - 1349
Main Authors: DEN BOON, S., VERVER, S., LOMBARD, C. J., BATEMAN, E. D., IRUSEN, E. M., ENARSON, D. A., BORGDORFF, M. W., BEYERS, N.
Format: Journal Article
Language:English
Published: Cambridge, UK Cambridge University Press 01.10.2008
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antitubercular Agents - therapeutic use
Bacterial diseases
Biological and medical sciences
Cough - etiology
Disease transmission
Female
Fever - etiology
Fundamental and applied biological sciences. Psychology
Health outcomes
Hemoptysis - etiology
Human bacterial diseases
Humans
Infectious diseases
Lung diseases
Male
Medical sciences
Microbiology
Middle Aged
Mycobacterium tuberculosis
Operating rooms
Original Papers
Pulmonary tuberculosis
South Africa
Sputum
Sweating
Symptoms
Treatment Outcome
Tuberculosis
Tuberculosis - diagnosis
Tuberculosis - drug therapy
Tuberculosis - physiopathology
Tuberculosis and atypical mycobacterial infections
Weight Loss
South Africa
Infection
Human
Prognosis
Treatment
Tuberculosis
Microbiology
Bacteriosis
Mycobacterial infection
Detection
Epidemiology
ISSN:0950-2688, 1469-4409
Online Access:Get full text
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Summary:Passive detection of tuberculosis (TB) cases may lead to delay in treatment which may contribute to increased severity of disease and mortality. Active case finding may be an alternative. In a community survey in Cape Town, South Africa, we actively detected 27 bacteriologically positive TB cases and compared those with 473 passively detected TB cases. Seven of 27 (26%) actively detected TB cases did not start treatment within 2 months and were considered initial defaulters. Those who did start treatment had similar treatment success rates as passively detected TB cases (both 80%) (OR 1·01, 95% CI 0·33–3·09). Passively detected cases reported the presence of the symptoms cough (OR 3·72, 95% CI 1·47–9·39), haemoptysis (OR 3·20, 95% CI 1·03–9·93), night sweats (OR 3·35, 95% CI 1·40–7·99), fever (OR 4·28, 95% CI 1·21–15·14), and weight loss (OR 11·14, 95% CI 4·17–29·74) more often than those detected actively. We conclude that although TB cases detected by a community survey are less symptomatic and are prone to a high initial default rate, active case finding can potentially identify a substantial portion of the existing caseload at an earlier stage of disease, thereby reducing the risk of transmission.
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ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268807000106