title: Comparison of symptoms and treatment outcomes between actively and passively detected tuberculosis cases: the additional value of active case finding.
abstract: 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, 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.
authors.affiliation: Desmond Tutu TB Centre, Stellenbosch University, South Africa. saskiadenboon@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: den Boon
authors.forename: S
authors.initials: S
authors.lastname: Verver
authors.forename: C J
authors.initials: CJ
authors.lastname: Lombard
authors.forename: E D
authors.initials: ED
authors.lastname: Bateman
authors.forename: E M
authors.initials: EM
authors.lastname: Irusen
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.forename: M W
authors.initials: MW
authors.lastname: Borgdorff
authors.forename: N
authors.initials: N
authors.lastname: Beyers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D003371:Cough / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013019:South Africa; D013546:Sweating; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D015431:Weight Loss
chemical_list: D000995:Antitubercular Agents