Suggestive criteria for pulmonary tuberculosis in developing countries

Tuberculosis (TB) represents a major problem in developing countries. Diagnosis is often difficult and mainly relies on clinical criteria and simple laboratory examinations, as cultural methods and molecular biology are not available in most health facilities. In order to evaluate the reliability of clinical criteria to suggest pulmonary TB, a prospective survey was conducted in Wolisso Hospital, South-West Shewa region, Ethiopia. During the period from April 2006 to September 2008, data from 117 consecutive patients from which the diagnosis of TB was made by either positive sputum examination or by typical chest X-ray were examined. The objective was to identify simple and reproducible clinical and laboratory criteria related to pulmonary TB in low-resource health facilities. Patients' symptoms strongly suggesting pulmonary TB were found to be long-lasting cough (>1month), dyspnoea, chest pain, weight loss, fever, weakness and night sweats; typical TB patients' physical examination showed emaciated condition, with low systolic blood pressure (BP) and low body mass index (BMI); simple laboratory examinations suggestive of TB were high erythrocyte sedimentation rate (ESR) and normocytic anaemia. Absence of both known TB contact and bloody sputum was not significant to rule out TB, and total and differential white blood cells (WBC) count did not help in the diagnosis.