title: Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia.
abstract: METHODS
  Four clinics in The Gambia.
  
  
  OBJECTIVE
  To document clinical and radiographic presentations of sputum smear-positive tuberculosis in adults.
  
  
  METHODS
  Newly diagnosed acid-fast bacilli (AFB) smear, culture-positive tuberculosis patients aged > or = 15 years were interviewed and examined, and underwent tuberculin skin testing, HIV testing and chest X-ray reviewed by a chest physician using set criteria.
  
  
  RESULTS
  Of 340 patients enrolled (median age 29 years; males 73%), 8.3% were HIV-positive. One-third reported haemoptysis, > 90% reported weight loss and fever, and wasting was the most common sign (69%). Crepitations were the most frequent auscultatory finding (41%). The most common radiological lesion was a patchy infiltrate (> 90%). Cavitation was present in 206 patients (60.6%), most frequently occurred in the upper lung fields, was associated with increasing bacterial load in the sputum, and was less prevalent in HIV-positive patients (45% vs. 62%; P = 0.07). Auscultatory and chest X-ray findings matched only one-third of the time.
  
  
  CONCLUSIONS
  In our setting, wasting is the most common clinical sign of sputum smear-positive tuberculosis. Auscultatory findings correlate poorly with radiological abnormalities. Cavitation is associated with increasing bacterial load in the sputum, and is therefore a strong indicator for early treatment.
authors.affiliation: University of Minnesota, Department of Medicine, Minneapolis, Minnesota, USA.
authors.forename: G
authors.initials: G
authors.lastname: Rathman
authors.forename: J
authors.initials: J
authors.lastname: Sillah
authors.forename: P C
authors.initials: PC
authors.lastname: Hill
authors.forename: J F
authors.initials: JF
authors.lastname: Murray
authors.forename: R
authors.initials: R
authors.lastname: Adegbola
authors.forename: T
authors.initials: T
authors.lastname: Corrah
authors.forename: C
authors.initials: C
authors.lastname: Lienhardt
authors.forename: K P W J
authors.initials: KP
authors.lastname: McAdam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005714:Gambia; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013183:Sputum / Q000382:microbiology*; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000382:microbiology