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Comparison of symptoms and treatment outcomes between actively and passively detected tuberculosis cases: the additional value of active case finding

  • S. DEN BOON (a1) (a2) (a3), S. VERVER (a2) (a3), C. J. LOMBARD (a4), E. D. BATEMAN (a5), E. M. IRUSEN (a6), D. A. ENARSON (a7), M. W. BORGDORFF (a2) (a3) and N. BEYERS (a1)
  • DOI:
  • Published online: 04 January 2008

Passive detection of tuberculosis (TB) cases may lead to delay in treatment which may contribute to increased severity of disease and mortality. Active case finding may be an alternative. In a community survey in Cape Town, South Africa, we actively detected 27 bacteriologically positive TB cases and compared those with 473 passively detected TB cases. Seven of 27 (26%) actively detected TB cases did not start treatment within 2 months and were considered initial defaulters. Those who did start treatment had similar treatment success rates as passively detected TB cases (both 80%) (OR 1·01, 95% CI 0·33–3·09). Passively detected cases reported the presence of the symptoms cough (OR 3·72, 95% CI 1·47–9·39), haemoptysis (OR 3·20, 95% CI 1·03–9·93), night sweats (OR 3·35, 95% CI 1·40–7·99), fever (OR 4·28, 95% CI 1·21–15·14), and weight loss (OR 11·14, 95% CI 4·17–29·74) more often than those detected actively. We conclude that although TB cases detected by a community survey are less symptomatic and are prone to a high initial default rate, active case finding can potentially identify a substantial portion of the existing caseload at an earlier stage of disease, thereby reducing the risk of transmission.

Corresponding author
*Author for correspondence: Dr S. den Boon, KNCV Tuberculosis Foundation, PO Box 146, 2501 CC The Hague, The Netherlands. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. MC Raviglione , MW Uplekar . WHO's new Stop TB Strategy. Lancet 2006; 367: 952955.

6. Western Cape Tuberculosis Program. Health Facility Report for Uitsig Clinic and Ravensmead Clinic 2002. Western Cape Department of Health: Cape Town, South Africa, 2003.

7. S Den Boon , High prevalence of previously treated tuberculosis among undetected cases of tuberculosis in Cape Town, South Africa. Emerging Infectious Diseases 2007; 13: 11891194.

11. A Cassels , Tuberculoses case-finding in Eastern Nepal. Tubercle 1982; 63: 175185.

12. M Monney , J Zellweger . Active and passive screening for tuberculosis in Vaud Canton, Switzerland. Swiss Medical Weekly 2005; 135: 469474.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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