title: Management of pulmonary tuberculosis suspects with negative sputum smears and normal or minimally abnormal chest radiographs in resource-poor settings.
abstract: METHODS
  Queen Elizabeth Central Hospital, Blantyre, Malawi.
  
  
  OBJECTIVE
  1) To determine the proportion of pulmonary tuberculosis (PTB) suspects with negative sputum smears and a normal/minimally abnormal chest radiograph (CXR) who are culture-positive for Mycobacterium tuberculosis, and 2) to determine how many develop smear or radiographic evidence of PTB (TB CXR) during follow-up.
  
  
  METHODS
  PTB suspects with negative sputum smears and a normal/minimally abnormal CXR were given a second course of antibiotics and followed up at 3-week intervals over 3 months with repeat sputum smears and chest radiography.
  
  
  RESULTS
  Of 79 patients (38 men and 41 women, mean age 33 years) with negative smears and a normal/minimally abnormal CXR, 16 (21%) were culture-positive for M. tuberculosis. Of 15 culture-positive patients who were alive and attended follow-up, seven (47%) developed a TB-CXR by 3 months. Of 41 culture-negative patients who were alive and attended follow-up, 13 (32%) developed a TB-CXR, including one patient who became sputum smear-positive. TB-CXRs were found only in patients with a cough.
  
  
  CONCLUSIONS
  TB suspects with negative smears and normal/minimally abnormal CXRs in high human immunodeficiency virus (HIV) prevalent countries should be given a second course of antibiotics. If cough improves, patients can be advised not to return for further follow-up. If cough continues, patients should return for further follow-up with sputum smear examination and chest radiography. Approximately 50% of those who have culture-positive PTB will develop a TB-CXR by 3 months and can be identified if radiographic facilities are available.
authors.affiliation: Department of Medicine, College of Medicine, Blantyre, Malawi.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: H T
authors.initials: HT
authors.lastname: Banda
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeree
authors.forename: S
authors.initials: S
authors.lastname: Welby
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirima
authors.forename: V R
authors.initials: VR
authors.lastname: Subramanyam
authors.forename: D
authors.initials: D
authors.lastname: Maher
authors.forename: P
authors.initials: P
authors.lastname: Nunn
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003906:Developing Countries; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents