title: Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo.
abstract: BACKGROUND
  The diagnosis of pulmonary tuberculosis (PTB) and smear-negative pulmonary tuberculosis (SNPT) in resource-limited countries is often solely based on clinical signs, chest X-ray radiography and sputum smear microscopy. We investigated currently used methods for the routine diagnosis of SNPT in the Republic of Congo (RoC) among TB suspected patients. The specific case of HIV positive patients was also studied.
  
  
  METHODS
  A cross-sectional study was conducted at the anti-tuberculosis center (CAT) of Brazzaville, RoC. Tuberculosis suspects were examined for physical signs of TB. Clinical signs, results from sputum smear microscopy, tuberculin skin test (TST) and chest X-ray were recorded.
  
  
  RESULTS
  Of the 772 enrolled participants, 372 were diagnosed PTB. Cough was a common symptom for PTB and no PTB patients. Pale skin, positive TST, weight loss and chest X-ray with abnormalities compatible with PTB (PTB-CXR) were significant indicators of PTB. Thirty-six percent of PTB patients were diagnosed SNPT. This category of patients presented less persistent cough and less PTB-CXR. Anorexia and asthenia were significant indicators of SNPT. In the case of HIV+ patients, 57% were SNPT with anorexia, asthenia and shorter cough being strong indicators of SNPT.
  
  
  CONCLUSIONS
  Chest X-ray abnormalities, weight loss, pale skin and positive TST were significant indicators of PTB. Anorexia and asthenia showed good diagnostic performance for SNPT, which deserve to be recommended as index indicators of SNPT diagnosis. Duration of cough is also a relevant indicator, especially for HIV+ patients.
authors.affiliation: Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. linguissi@gmail.com.|Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Labiogene, Université de Ouagadougou, 01 BP 364, Ouaga 01, Burkina Faso. linguissi@gmail.com.
authors.forename: Laure Stella Ghoma
authors.initials: LS
authors.lastname: Linguissi
authors.affiliation: Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. vjeannhey@yahoo.fr.
authors.forename: Christevy Jeannhey
authors.initials: CJ
authors.lastname: Vouvoungui
authors.affiliation: Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. pierre.poulain@cupnet.net.|Institut National de la Santé et de la Recherche Médicale U 1134, Paris, France. pierre.poulain@cupnet.net.|UMR_S 1134, DSIMB, Université Paris Diderot, Sorbonne Paris Cite, Paris, France. pierre.poulain@cupnet.net.|Institut National de la Transfusion Sanguine, DSIMB, Paris, France. pierre.poulain@cupnet.net.|UMR_S 1134, Laboratory of Excellence GR-Ex, DSIMB, Paris, France. pierre.poulain@cupnet.net.
authors.forename: Pierre
authors.initials: P
authors.lastname: Poulain
authors.affiliation: Centre Antituberculeux de Brazzaville, Programme de Lutte contre la Tuberculose, Brazzaville, Republic of Congo. info@fcrm-congo.com.
authors.forename: Gaston Bango
authors.initials: GB
authors.lastname: Essassa
authors.affiliation: Capacity for Leadership Excellence and Research, CLEAR, INC, Yaoundé, Cameroon. bellasylk@yahoo.com.|Faculty of Médecine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon. bellasylk@yahoo.com.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Kwedi
authors.affiliation: Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. fntoumi@fcrm-congo.com.|Faculty of Sciences and Techniques, University Marien Ngouabi, BP 2672, Brazzaville, Republic of Congo. fntoumi@fcrm-congo.com.|Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany. fntoumi@fcrm-congo.com.
authors.forename: Francine
authors.initials: F
authors.lastname: Ntoumi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003223:Congo; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult