{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T16:26:29Z","timestamp":1758126389200},"reference-count":35,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>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\u201367) 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.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0023","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T14:57:38Z","timestamp":1692629858000},"page":"733-739","source":"Crossref","is-referenced-by-count":1,"title":["Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania"],"prefix":"10.4269","volume":"109","author":[{"given":"Michael J.","family":"Maze","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gissela","family":"Nyakunga","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philoteus A.","family":"Sakasaka","sequence":"additional","affiliation":[{"name":"Kilimanjaro Clinical Research Institute, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kajiru G.","family":"Kilonzo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisha","family":"Luhwago","sequence":"additional","affiliation":[{"name":"Mawenzi Regional Referral Hospital, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manase","family":"Chelangwa","sequence":"additional","affiliation":[{"name":"Ministry of Health and Social Welfare, Dodoma, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Crump","sequence":"additional","affiliation":[{"name":"Centre for International Health, University of Otago, Dunedin, New Zealand;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riziki M.","family":"Kisonga","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Kibong\u2019oto, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deng B.","family":"Madut","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Rogath","sequence":"additional","affiliation":[{"name":"Mawenzi Regional Referral Hospital, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan","family":"Sadiq","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rennae","family":"Thiessen","sequence":"additional","affiliation":[{"name":"Radiology Department, Canterbury District Health Board, Christchurch, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew P.","family":"Rubach","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Global Tuberculosis Report 2020","year":"2020"},{"key":"b2","series-title":"Definitions and Reporting Framework for Tuberculosis\u20142013 Revision","year":"2020"},{"key":"b3","series-title":"Global Tuberculosis Case Notifications Dataset","year":"2022"},{"key":"b4","series-title":"Sci Rep","first-page":"14854","article-title":"The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes","volume":"11","author":"Abdullahi","year":"2021"},{"key":"b5","series-title":"Int J Tuberc Lung Dis","first-page":"847","article-title":"\u2018Smear-negative\u2019 pulmonary tuberculosis in a DOTS programme: poor outcomes in an area of high HIV seroprevalence","volume":"5","author":"Hargreaves","year":"2001"},{"key":"b6","series-title":"Respir Res","first-page":"251","article-title":"Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis","volume":"22","author":"Teo","year":"2021"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"e1","article-title":"Official American Thoracic Society\/Infectious Diseases Society of America\/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children","volume":"64","author":"Lewinsohn","year":"2017"},{"key":"b8","series-title":"BMC Public Health","first-page":"68","article-title":"Sputum microscopy for the diagnosis of HIV-associated pulmonary tuberculosis in Tanzania","volume":"8","author":"Matee","year":"2008"},{"key":"b9","series-title":"PLoS One","first-page":"e1536","article-title":"Commercial nucleic-acid amplification tests for diagnosis of pulmonary tuberculosis in respiratory specimens: meta-analysis and meta-regression","volume":"3","author":"Ling","year":"2008"},{"key":"b10","series-title":"Lancet Infect Dis","first-page":"544","article-title":"Burden of tuberculosis at post mortem in inpatients at a tertiary referral centre in sub-Saharan Africa: a prospective descriptive autopsy study","volume":"15","author":"Bates","year":"2015"},{"key":"b11","series-title":"Thorax","first-page":"50","article-title":"Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis","volume":"78","author":"Jayasooriya","year":"2023"},{"key":"b12","series-title":"Int J Tuberc Lung Dis","first-page":"1056","article-title":"Chronic pulmonary aspergillosis as a cause of smear-negative TB and\/or TB treatment failure in Nigerians","volume":"21","author":"Oladele","year":"2017"},{"key":"b13","series-title":"Trop Doct","first-page":"120","article-title":"Bronchiectasis: frequent misdiagnosis in sub-Saharan Africa","volume":"29","author":"Lawn","year":"1999"},{"key":"b14","series-title":"Trans R Soc Trop Med Hyg","first-page":"504","article-title":"Histoplasmosis among hospitalized febrile patients in northern Tanzania","volume":"106","author":"Lofgren","year":"2012"},{"key":"b15","series-title":"Trans R Soc Trop Med Hyg","first-page":"402","article-title":"Pneumocystis carinii pneumonia in patients being registered for smear-negative pulmonary tuberculosis in Malawi","volume":"95","author":"Hargreaves","year":"2001"},{"key":"b16","series-title":"J Clin Tuberc Other Mycobact Dis","first-page":"100263","article-title":"Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: a retrospective cohort study","volume":"24","author":"Bukundi","year":"2021"},{"key":"b17","year":"2018"},{"key":"b18","series-title":"J Clin Tuberc Other Mycobact Dis","first-page":"100100","article-title":"Diagnosing pulmonary tuberculosis by pooling induced sputum","volume":"11","author":"Chew","year":"2019"},{"key":"b19","series-title":"Clin Med (Lond)","first-page":"538","article-title":"Community-acquired pneumonia","volume":"12","author":"Brown","year":"2012"},{"key":"b20","series-title":"Am J Respir Crit Care Med","first-page":"647","article-title":"Non-cystic fibrosis bronchiectasis","volume":"188","author":"McShane","year":"2013"},{"key":"b21","author":"Klompas","year":"2023"},{"key":"b22","series-title":"Eur Respir J","first-page":"1542","article-title":"Pulmonary infection with Nocardia species: a report of 10 cases and review","volume":"10","author":"Menendez","year":"1997"},{"key":"b23","series-title":"Eur Respir J","first-page":"45","article-title":"Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management","volume":"47","author":"Denning","year":"2016"},{"key":"b24","series-title":"Semin Respir Crit Care Med","first-page":"141","article-title":"Pulmonary cryptococcosis","volume":"29","author":"Jarvis","year":"2008"},{"key":"b25","series-title":"Clin Infect Dis","first-page":"448","article-title":"A multicenter evaluation of tests for diagnosis of histoplasmosis","volume":"53","author":"Hage","year":"2011"},{"key":"b26","series-title":"Am J Respir Crit Care Med","first-page":"733","article-title":"An official American Thoracic Society\/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias","volume":"188","author":"Travis","year":"2013"},{"key":"b27","author":"Hartung","year":"2010"},{"key":"b28","series-title":"BMC Pulm Med","first-page":"146","article-title":"Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis","volume":"20","author":"Luo","year":"2020"},{"key":"b29","series-title":"Eur Respir J","first-page":"1800098","article-title":"The World Health Organization standards for tuberculosis care and management","volume":"51","author":"Gilpin","year":"2018"},{"key":"b30","series-title":"Chest Radiography in Tuberculosis Detection: Summary of Current WHO Recommendations and Guidance on Programmatic Approaches","year":"2016"},{"key":"b31","series-title":"Manual for the Management of Tuberculosis and Leprosy","year":"2013"},{"key":"b32","series-title":"Thorax","first-page":"1131","article-title":"Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study","volume":"77","author":"Nightingale","year":"2022"},{"key":"b33","series-title":"BMC Res Notes","first-page":"475","article-title":"Sputum smear negative pulmonary tuberculosis: sensitivity and specificity of diagnostic algorithm","volume":"4","author":"Swai","year":"2011"},{"key":"b34","series-title":"Thorax","first-page":"1010","article-title":"Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis","volume":"57","author":"McWilliams","year":"2002"},{"key":"b35","series-title":"Int J Tuberc Lung Dis","first-page":"829","article-title":"Long-term outcome in patients registered with tuberculosis in Zomba, Malawi: mortality at 7 years according to initial HIV status and type of TB","volume":"8","author":"Kang\u2019ombe","year":"2004"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/4\/article-p733.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/4\/article-p733.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/4\/article-p733.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T12:45:33Z","timestamp":1696423533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/4\/article-p733.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,4]]},"references-count":35,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0023","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,4]]}}}