title: Characteristics of Patients with Smear-Negative Pulmonary Tuberculosis (TB) in a Region with High TB and HIV Prevalence.
abstract: Smear-negative pulmonary TB (SNPT) represents 30-60% of all pulmonary TB cases. The mortality of these patients can reach 25% in populations with high prevalence of HIV infection, and 10-20% of TB transmission at the population level are attributable to SNPT cases.
  
  
  
  We conducted a retrospective study to evaluate epidemiological, clinical, and radiological characteristics of patients with SNPT and to compare these with patients who were diagnosed as having smear-positive pulmonary TB (SPPT). All adult patients (≥ 18 years old) with a positive culture for Mycobacterium tuberculosis, and a diagnosis of pulmonary TB were included in the study.
  
  
  
  198 patients met the inclusion criteria (positive culture for Mycobacterium tuberculosis) and were included in the analysis. Of these patients, 69 (34.8%) were smear positive (SPPT) and 129 (65.2%) were smear negative (SNPT). In univariate analysis, cough, dyspnea, and hemoptysis were less frequent in SNPT patients in comparison with SPPT patients. In a multivariate model, having no cough and no radiographic pattern typical of TB were the characteristics independently associated with a diagnosis of SNPT.
  
  
  
  We found a very high prevalence of SNPT among patients with TB in a setting with high TB and HIV prevalence. The absence of cough in the presence of other symptoms suggestive of TB, and having no radiographic pattern typical of TB where independent predictors of SNPT.
authors.affiliation: Programa de Pós-Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Brazil.
authors.forename: Leandro Cruz
authors.initials: LC
authors.lastname: Campos
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcos Vinícius Vieira
authors.initials: MV
authors.lastname: Rocha
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Denise Maria Cunha
authors.initials: DM
authors.lastname: Willers
authors.affiliation: Programa de Pós-Graduação em Ciências Pneumológicas, UFRGS, Porto Alegre, Brazil.|Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.|Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Denise Rossato
authors.initials: DR
authors.lastname: Silva
mesh_terms: D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D015995:Prevalence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology