title: Symptom screen for identification of highly infectious tuberculosis in people living with HIV in Southeast Asia.
abstract: BACKGROUND
  Tuberculosis (TB) is the leading cause of death among people living with HIV and frequently transmitted among this susceptible group. Transmission can be reduced by infection control practices. Simple evidence-based methods to identify patients who should be isolated are not well described in the literature. We sought to identify a simple, sensitive symptom or symptom combination that healthcare providers in resource-limited settings can use to identify and isolate persons living with HIV with highly infectious TB.
  
  
  METHODS
  Participants from 8 outpatient facilities in Cambodia, Thailand, and Vietnam underwent an extensive evaluation for TB. Patients with ≥1 positive sputum smear and Mycobacterium tuberculosis culture growth from a pulmonary site were defined as having highly infectious TB. We calculated sensitivity and prevalence of individual symptoms and >1000 symptom combinations.
  
  
  RESULTS
  Of 1980 participants, 272 (14%) had TB. Forty percent (n = 109) were highly infectious. Sensitivity for detecting highly infectious TB was highest for having the following symptoms in the past month as follows: weight loss (84%), cough (83%), fever (81%), and fatigue (78%); however, these symptoms were found in 46%-54% of all participants. Having 2 or 3 of 4 symptoms (prevalence, 26%-47%)-weight loss, fever, current cough, and night sweats-was 72%-90% sensitive for highly infectious TB.
  
  
  CONCLUSIONS
  The 2 or 3 of 4 symptom combinations of weight loss, fever, current cough, and night sweats, which are the same symptoms comprising the current World Health Organization-recommended TB diagnostic screen, are sensitive for detecting highly infectious TB in people living with HIV.
authors.affiliation: Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. iyn2@cdc.gov
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
authors.forename: Charles M
authors.initials: CM
authors.lastname: Heilig
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: McCarthy
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.forename: Phalkun
authors.initials: P
authors.lastname: Chheng
authors.forename: Nong
authors.initials: N
authors.lastname: Kanara
authors.forename: Hoang Thi
authors.initials: HT
authors.lastname: Quy
authors.forename: Borann
authors.initials: B
authors.lastname: Sar
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Cain
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
mesh_terms: D000328:Adult; D000368:Aged; D001210:Asia, Southeastern; D015510:Clinical Medicine / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult