title: Extra-pulmonary and smear-negative forms of tuberculosis are associated with treatment delay and hospitalisation.
abstract: METHODS
  Adult patients with tuberculosis (TB) recruited at the chest clinic of the University Teaching Hospital in Lusaka, Zambia, from 2003 to 2004.
  
  
  OBJECTIVE
  To identify factors associated with delayed treatment or hospitalisation.
  
  
  METHODS
  A cross-sectional survey of newly identified adult patients with TB.
  
  
  RESULTS
  A total of 223 patients were included in the analysis. Patients with smear-negative disease were 2.6 times more likely to be hospitalised than those with smear-positive disease (95%CI 1.28-5.30), while patients with extra-pulmonary disease were 3.42 times more likely to be hospitalised than those with pulmonary disease (95%CI 1.75-6.66). Patients with smear-negative disease were 2.81 times more likely to have experienced overall delay than those with smear-positive disease (95%CI 1.20-6.66).
  
  
  CONCLUSIONS
  This analysis has demonstrated that patients with extra-pulmonary or smear-negative disease are significantly more likely to be hospitalised. Patients with smear-negative disease are also more likely to have experienced treatment delay. These data reinforce the urgent need for more robust diagnostic tests, particularly for smear-negative and extra-pulmonary disease. As these forms of disease are more likely to be associated with the human immunodeficiency virus (HIV), the data support earlier diagnosis and treatment of HIV infection.
authors.affiliation: Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK. james.whitehorn@lshtm.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Whitehorn
authors.forename: H
authors.initials: H
authors.lastname: Ayles
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011379:Prognosis; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D015024:Zambia / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents