Abstract

Objective

To determine the predictive value of constitutional symptoms, chest X-ray (CXR) interpretation by non-lung specialist clinicians, Erythrocyte Sedimentation Rate (ESR), White Blood cell Count (WBC) and Haemoglobin-level (Hb) on treatment outcome in sputum smear (SS) negative pulmonary tuberculosis (TB) patients.

Setting

Two small hospitals in the southern part of Malawi, where HIV-prevalence among TB-patients is 80%.

Methods

A retrospectively constructed cohort of TB-patients, who were SS-negative and did not respond to one course of antibiotics, was followed up to 11 months.

Results

Poor survival was found in the groups with a non-TB CXR, a low WBC, an ESR of 100-124 mm/hr or a low Hb (only in first 3 months). A better prognosis was found for patients with a diagnosis of TB on CXR and patients with a high WBC. Especially the WBC and CXR showed remarkable differences.

Conclusion

Diagnosis of tuberculosis in high HIV- prevalent resource-poor settings remains difficult when SS are negative and CXRs do not show evidence of TB. Except for the WBC, the studied tests were not very specific. A second course of antibiotics could be given to rule out pneumonia, especially in patients with a high WBC.