{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:31:51Z","timestamp":1767846711638,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2006,2,21]],"date-time":"2006-02-21T00:00:00Z","timestamp":1140480000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2006,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objectives\u2002<\/jats:bold> To develop and validate clinical guidelines for diagnosis of smear\u2010negative pulmonary tuberculosis (TB) in developing countries with low\u2010HIV prevalence.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> We developed diagnostic guidelines for smear\u2010negative TB. Clinical diagnoses based on these guidelines were compared with sputum culture, chest X\u2010rays and reports of an expert panel.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> The guidelines achieved a sensitivity of 0.59 [confidence interval (CI) 0.46\u20130.66] and a specificity of 0.86 (CI 0.84\u20130.88) in diagnosing smear\u2010negative TB. A total of 6.8% of patients who initially improved after a course of antibiotics were later confirmed to have TB. Clinicians detected an abnormal chest X\u2010ray in 92% (CI 88\u201396%) and radiological signs of pulmonary TB in 98% (CI 94\u2013100%) of cases.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Our experience highlights a number of dilemmas faced in developing, testing and implementing diagnostic guidelines in poorly resourced conditions. Using radiological criteria for TB and appropriate training can help in improving the diagnostic skills of primary care clinicians working in low\u2010HIV settings with access to X\u2010ray facilities. But a significant number of apparently smear\u2010negative TB cases may in fact be smear positive and TB programmes should focus on improving the quality of direct acid\u2010fast bacilli microscopy. The value of an antibiotic trial is questionable due to the relatively large number of false negatives generated by this approach.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2006.01559.x","type":"journal-article","created":{"date-parts":[[2006,2,21]],"date-time":"2006-02-21T14:57:24Z","timestamp":1140533844000},"page":"323-331","source":"Crossref","is-referenced-by-count":23,"title":["Clinical guidelines to diagnose smear\u2010negative pulmonary tuberculosis in Pakistan, a country with low\u2010HIV prevalence"],"prefix":"10.1111","volume":"11","author":[{"given":"Kamran","family":"Siddiqi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Walley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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