{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:35:32Z","timestamp":1785324932463,"version":"3.55.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T00:00:00Z","timestamp":1641254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pulmonary tuberculosis infection can manifest in different states, including subclinical tuberculosis. It is commonly defined as confirmed tuberculosis without the classic symptoms (commonly, persistent cough for \u22652 weeks). This narrow definition likely poses limitations for surveillance and control measures. The aims of the current study were to characterize the clinical presentation of tuberculosis; estimate the prevalence of subclinical tuberculosis among individuals with bacteriologically confirmed tuberculosis, using various definitions; and investigate risk factors for subclinical as opposed to clinical tuberculosis in a population-based survey.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a secondary analysis of data from a nationally representative tuberculosis prevalence survey from Zambia in 2013\u20132014, in which participants were screened for tuberculosis based on chest radiographic findings and symptoms. Tuberculosis was defined as culture-positive or GeneXpert MTB\/RIF test\u2013positive sputum. Risk factors for subclinical tuberculosis were assessed by means of multivariable logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 257 participants with confirmed tuberculosis, 104 (40.5%) were without cough persisting \u22652 weeks. Only 23 (22.1%) of these did not present with any other common symptoms. Those without cough persisting \u22652 weeks frequently reported other symptoms, particularly chest pain (46.2%) and weight loss (38.5%); 36 (34.6%) reported experiencing other symptoms persisting \u22654 weeks. Female subjects were more likely to report no cough persisting \u22652 weeks, as were relatively wealthier individuals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The commonly used definition of subclinical tuberculosis includes a large proportion of individuals who have other tuberculosis-suggestive symptoms. Requiring cough \u22652 weeks for tuberculosis diagnosis likely misses many active tuberculosis infections and allows a large reservoir of likely transmissible tuberculosis to remain undetected.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab1050","type":"journal-article","created":{"date-parts":[[2022,1,3]],"date-time":"2022-01-03T20:09:37Z","timestamp":1641240577000},"page":"842-848","source":"Crossref","is-referenced-by-count":32,"title":["How \u201cSubclinical\u201d is Subclinical Tuberculosis? An Analysis of National Prevalence Survey Data from Zambia"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6825-3472","authenticated-orcid":false,"given":"Logan","family":"Stuck","sequence":"first","affiliation":[{"name":"Department of Global Health, Amsterdam University Medical Centers , Amsterdam , the Netherlands"},{"name":"Amsterdam Institute for Global Health and Development , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee Claire","family":"van Haaster","sequence":"additional","affiliation":[{"name":"Amsterdam Institute for Global Health and Development , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascalina","family":"Kapata-Chanda","sequence":"additional","affiliation":[{"name":"Ministry of Health , Lusaka , Zambia and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eveline","family":"Klinkenberg","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam University Medical Centers , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Kapata","sequence":"additional","affiliation":[{"name":"Ministry of Health , Lusaka , Zambia and"},{"name":"Zambia National Public Health Institute , Lusaka , Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Cobelens","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam University Medical Centers , Amsterdam , the Netherlands"},{"name":"Amsterdam Institute for Global Health and Development , Amsterdam , the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,1,4]]},"reference":[{"key":"2022091519081088600_CIT0001","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1038\/nrmicro2236","article-title":"The spectrum of latent tuberculosis: rethinking the goals of prophylaxis.","volume":"7","author":"Barry","year":"2009","journal-title":"Nat Rev Microbiol"},{"key":"2022091519081088600_CIT0002","doi-asserted-by":"crossref","first-page":"e00021-18","DOI":"10.1128\/CMR.00021-18","article-title":"Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection.","volume":"31","author":"Drain","year":"2018","journal-title":"Clin Microbiol Rev"},{"key":"2022091519081088600_CIT0003","doi-asserted-by":"crossref","first-page":"e830","DOI":"10.1093\/cid\/ciaa1402","article-title":"Subclinical tuberculosis disease\u2014a review and analysis of prevalence surveys to inform definitions, 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