A Population-Based Survey of Tuberculosis Symptoms

How Atypical Are Atypical Presentations?

Published in: Clinical Infectious Diseases, v. 30, no. 2, Feb. 2000, p. 293-299

Posted on RAND.org on December 31, 1999

by Loren G. Miller, Steven M. Asch, Emily I. Yu, Laura Knowles, Lillian Gelberg, Paul Davidson

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There is scant information on tuberculosis symptoms from a population-based perspective. The authors prospectively identified 526 tuberculosis cases reported in Los Angeles County over a 6-month period. Of 313 persons who completed their questionnaire, 72.7% had cough, 48.2% for >2 weeks, and 52.3% had fever, 29.4% for >2 weeks. Among those with pulmonary disease, only 52.4% had cough for >2 weeks. In a multivariate model, persons with significant symptoms typical of tuberculosis disease (defined as cough or fever for >2 weeks, weight loss, or hemoptysis) were associated with lack of medical insurance, negative tuberculin skin test, diagnosis during a process other than screening, and non-Asian race. In summary, classic symptoms of prolonged cough and fever are insensitive predictors of tuberculosis. The data suggest that Asians may need to be added to the list of persons who present with tuberculosis atypically. The authors believe that the Infectious Diseases Society of America guidelines for community-acquired pneumonia should emphasize demographic features in addition to clinical symptoms when suggesting which patients require evaluation for Mycobacterium tuberculosis.

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