Most people with tuberculosis do not report a persistent cough | Top Vip News

A significant proportion of community-based people with pulmonary tuberculosis (TB) have subclinical disease, according to a meta-analysis including survey studies in Africa and Asia.

In adjusted analyses, 82.8% (95% CI: 78.6-86.6) of participants with tuberculosis reported no persistent cough and 62.5% (95% CI: 56.6-68 ,7) reported no cough at all, according to Frank Cobelens, MD, MSc, PhD, of the Amsterdam Institute for Global Health and Development, and colleagues at the scTB Meta Investigator Group.

Furthermore, the findings in Infectious lancet disease showed that 27.7% (95% CI: 21.0-36.4) of participants with TB did not report any symptoms suggestive of the disease, including cough, chest pain, fever, night sweats or loss of vision. weight.

“A persistent cough is often the entry point for a diagnosis, but if 80% of people with tuberculosis do not have it, then it means that the diagnosis will come later, possibly after the infection has already been transmitted to many others – or nothing at all,” Cobelens said in a press release.

“Our results indicate the likely reason why, despite enormous efforts to diagnose and treat the disease, [TB] “The load in Africa and Asia is barely decreasing,” he added. “It is clear that current practice, especially in the most resource-poor settings, will miss large numbers of TB patients. Instead, we should focus on X-ray screening and the development of new inexpensive tests and easy to use.

The meta-analysis included data from a dozen surveys conducted in four Asian and eight African countries with high TB ​​incidence over the past two decades, ultimately including more than 600,000 people, 1,944 of whom had TB.

Of participants with tuberculosis, 29.1% (95% CI: 25.2-33.3) of those without persistent cough and 23.1% (95% CI: 1.8-27. 4) Of those without cough had positive sputum smears, suggesting infectiousness, the study authors noted. . The research team also found that tuberculosis without cough occurred more frequently among women than men, although they cautioned that “it is possible that men with subclinical tuberculosis participated less frequently in the surveys (for example, because they were absent for work). “.

In the US, more than 8,000 cases of the deadly infection were reported in 2022, a 5.9% increase from the previous year. According to the Centers for Disease Control and Preventionand an estimate 13 million people They live with latent infections.

Reynold Panettieri Jr., MD, of the Rutgers Institute for Translational Medicine and Science in New Brunswick, New Jersey, who was not involved in the study, said individual factors such as a patient’s immune status or even nutrition can influence how they manifest. the symptoms of tuberculosis.

“There are immunocompromised people in whom the infection may continue, but not cause, many symptoms because their immune system is not fighting the infection,” he said. MedPage today. “They are contagious, when coughing or sneezing they can produce tuberculin, but they may not have had symptoms because they do not have inflammation.”

Panettieri recommended frequent testing for tuberculosis using purified protein derivative (PPD) skin tests or blood tests when suspicion arises, particularly after direct exposure or if a patient is immunocompromised.

Study details

Data for the analysis come from 12 of 31 eligible surveys conducted in Cambodia, Ghana, Laos, Lesotho, Nigeria, Pakistan, South Africa, Sudan, Gambia, Uganda, Vietnam and Zambia that reported pulmonary tuberculosis prevalence and symptom detection among 2007 and 2020. Studies that primarily included children, pregnant people, people living with HIV, incarcerated people, immigrants, and household contacts of TB patients were excluded.

The majority of the 602,863 participants were from Africa, 57.6% were women, almost 60% lived in rural areas and about half were under 35 years old. Screening and diagnostic criteria were standardized across surveys and tuberculosis was defined by a positive sputum culture.

Models adjusted for age, sex, and urban versus rural settings.

The researchers examined three definitions of subclinical disease:

• No persistent cough: positive sputum culture but no cough lasting 2 weeks or longer before screening
• No cough: positive culture but no cough of any duration
• No symptoms: Positive culture but no cough, fever, chest pain, night sweats, or weight loss.

Cobelens and his co-authors emphasized that the main limitation of the study was that the regression models used did not take into account “HIV status, smoking, or indicators of socioeconomic status, because these data were not available for all surveys.” They also noted the small number of surveys ultimately used in the analysis.