Presenting symptoms of patients with active pulmonary tuberculosis in Singapore

A prospective study of 1,258 new cases of active pulmonary tuberculosis was conducted to identify their mode of presentation. About 70% of the patients were symptomatic. Symptom frequency increased with rising age, was higher among females and among those with more extensive disease. A higher proportion of symptomatics was found among the bacillary (83.5%) than among the abacillary (59.4%) cases. Differences in interview technique and composition of the two groups could not account for this large difference. It was suggested that this was due to some of the abacillary cases not being cases of tuberculosis at all. Cough was the most common presenting symptom and was present in 66.1% of bacillary cases. This finding contrasted with that of the 1975 prevalence survey where cough was reported in 24% of bacillary cases. The reasons for this difference was discussed and it was suggested that the proportion of bacillary cases with cough symptoms would be higher than what was previously reported. Cough of more than two weeks duration, weight loss, blood stained sputum and chest pain were more prevalent among tuberculosis patients than in other patients seen by private medical practitioners. It was suggested that a case detection programme based upon this set of symptoms would help identify the epidemiologically more important cases of tuberculosis. Such a programme should complement existing case detection programmes as it would be expected to miss a sizeable proportion of the abacillary cases with minimal pulmonary lesions.