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. 2023 Aug 21;109(4):733-739.
doi: 10.4269/ajtmh.23-0023. Print 2023 Oct 4.

Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania

Michael J Maze  1 , Gissela Nyakunga  2 , Philoteus A Sakasaka  3 , Kajiru G Kilonzo  2 , Elisha Luhwago  4 , Manase Chelangwa  5 , John A Crump  6 , Riziki M Kisonga  7 , Deng B Madut  8 , Josephine Rogath  4 , Adnan Sadiq  2 , Rennae Thiessen  9 , Matthew P Rubach  8
Affiliations

Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania

Michael J Maze et al. Am J Trop Med Hyg. .

Abstract

Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44-67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.

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Conflict of interest statement

Disclosure: The study was performed in accordance with the Declaration of Helsinki and all participants provided informed written consent. The study protocol was approved by the Kilimanjaro Christian Medical University College Research Ethics Committee (reference number 1155), the Tanzania National Institutes for Medical Research National Ethics Coordinating Committee (reference number NIMR/HQ/R.8c/Vol. I/1635), the University of Otago Human Ethics Committee (Health) (reference number H18/123), and the Duke University Institutional Review Board (Pro00103048).

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