Opportunistic Screening for Enhanced TB Case Detection among Inpatients in a Tertiary Care Hospital, Bengaluru

Tuberculosis (TB) remains a global health challenge, causing substantial illness and death. In India, the National Tuberculosis Elimination Programme (NTEP) has been working to combat TB, but eliminating the disease remains difficult. To improve TB case detection, a feasibility study took place at a tertiary care hospital in Bengaluru, India. The study's objective was to assess the occurrence of four TB symptom complexes among admitted patients in medicine, emergency medicine, and pediatrics wards and estimate the screening needed to identify one TB patient among these admissions.

From April to June 2023, a cross-sectional study was conducted at a 750-bed tertiary care hospital in Bengaluru, which had an established NTEP cell. The study encompassed all patients admitted to the medicine, emergency medicine, and pediatrics wards, with a calculated sample size of 1473 patients. Data collection was done using a validated questionnaire, and inpatients were screened for four TB symptom complexes: cough lasting over 14 days, fever or evening rise of temperature, night sweats, and significant weight loss. Positive cases were referred to a designated microscopy center (DMC) for sputum examination and further diagnosis and treatment.

Among the 1497 patients screened, 272 (18%) showed symptoms related to tuberculosis (TB). Out of these, 31 (11.3%) were confirmed to have TB through sputum examination and chest X-ray. The calculated number needed to screen (NNS) to identify one TB case among inpatients was 48. PTB cases were most prevalent in the 56-65 age group, whereas diagnosed TB patients were mainly in the 36-45 age group.

In conclusion, the daily screening of admitted patients in the Departments of Medicine, Emergency Medicine, and Pediatrics has yielded positive results and is deemed feasible for implementation within the medical college setting.