title: Can tuberculosis case finding among health-care seeking adults be improved? Observations from Bissau.
abstract: METHODS
  The Bandim Health Project study area in Bissau, Guinea-Bissau.
  
  
  OBJECTIVE
  To assess the potential usefulness of predictors (elsewhere applied) and clinical scores (TBscore and TBscore II) based on signs and symptoms typical of tuberculosis (TB) in case finding.
  
  
  METHODS
  Observational prospective cohort study of patients with signs and symptoms suggestive of pulmonary TB (PTB) from 2010 to 2012.
  
  
  RESULTS
  We included 1089 PTB suspects with a mean age of 34 years (95%CI 33-35); human immunodeficiency virus (HIV) prevalence was 15.1%. PTB was diagnosed in 107 suspects (76.4% sputum smear-positive, 25.2% HIV-infected). Cough > 2 weeks had the highest diagnostic ability (area under the receiver operating characteristic curve [AUC] 0.66, 95%CI 0.62-0.71), while TBscore < 3 best excluded PTB (negative likelihood ratio [LR-] 0.3) when HIV status was not known. TBscore II ≥ 3 had the highest diagnostic ability in HIV-infected PTB suspects (AUC 0.62, 95%CI 0.53-0.72), while the absence of self-reported weight loss best excluded PTB (LR- 0.2). Cough > 2 weeks as a trigger for smear microscopy missed 32.1% of smear-positive PTB cases.
  
  
  CONCLUSIONS
  Case finding could be improved by screening symptomatic adults for cough and/or weight loss using TBscore II as the trigger for smear microscopy. To suspect PTB only in patients with cough > 2 weeks (non-HIV-infected) or with current cough, fever, weight loss or night sweats (HIV-infected) was not effective in patients whose HIV status was unknown at first visit.
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: F
authors.initials: F
authors.lastname: Rudolf
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: T L
authors.initials: TL
authors.lastname: Haraldsdottir
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau.
authors.forename: M S
authors.initials: MS
authors.lastname: Mendes
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau.
authors.forename: A-J
authors.initials: AJ
authors.lastname: Wagner
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau.
authors.forename: V F
authors.initials: VF
authors.lastname: Gomes
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau.
authors.forename: P
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Eugen-Olsen
authors.affiliation: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001431:Bacteriological Techniques; D060085:Coinfection; D003371:Cough / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012372:ROC Curve; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D015431:Weight Loss