Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya

Abstract

Objective: To determine the diagnostic usefulness of tu- berculosis (TB) symptom screening to detect active pul- monary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for Inter- national Development–Academic Model Providing Access to Healthcare partnership. Design: Cross-sectional study. Participants were inter- viewed for TB symptoms with a standardized question- naire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted spu- tum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gesta- tion underwent shielded chest radiography (CXR). Results: Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and my- cobacterial cultures. CXRs were performed in 26 symp- tomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a nega- tive symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). Conclusion: This study did not support the utility of iso- lated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women